CASE PRESENTATION ON DENGUE
FEVER WITH THROMBOCYTOPENIA
PRESENTED BY
SUBJECTIVE EVIDENCE
• Chief compliant : Mrs. BS 37 YOF had complaints of high grade
fever since 3 days with chills and body pains .
• Past medical history : Not significant
• Past medication history : Not significant
• Allergies : NKDA
OBJECTIVE EVIDENCE
• General appearance :
Height = 158 cm
Weight = 54 kg
BMI = 21.6 kg/m² ( Normal )
• Vitals :
Temp - 104° F
Heart rate – 88 bpm
B.P – 110/70 mmHg
Respiratory rate – 24 breaths/min
LAB INVESTIGATION
TEST
RESULT
NORMAL VALUE
Hb
11.9g/dl
11-16g/dl
TLC
11,480cells/mm³*
4000-11000cells/mm³
PLATELETS
60,000*
150000-400000
ESR
28mm/hr
0-29mm/hr
TOTAL PROTEIN
6.0g/dl
6-8.3g/dl
AST
70 units/L*
10-40 units/L
POTASSIUM
3.2mmol/L
3.5-5.1mmol/L
ALT
61 units/L*
7-56 units/L
PREALBUMIN
14mg/dl*
16-40mg/dl
• Platelet count
• CUE :
Protein – positive
Leucocytes – positive ( traces )
Pus cells – 4 to 5/ hpf
Budding yeast – positive
• P . vivax and P . Falciparum
– negative
• Dengue NS1 antigen positive
DATE
PLATELET COUNT
17/9
60,000
18/9
60,000 ( 6 AM )
50,000 ( 5 PM )
19/9
28,000 ( 6 AM )
30,000 ( 1 PM )
20/9
23,000 – 38,000
21/9
49,000 ( 8:15 AM )
60,000 ( 7 PM )
22/9
68,000
23/9
1,21,000
Pharmaceutical care plan
SUBJECTIVE EVIDENCE
OBJECTIVE EVIDENCE
high grade fever since 3 days with chills
and body pains
PLATELETS 60,000
CUE :
Protein – positive
Leucocytes – positive ( traces )
Pus cells – 4 to 5/ hpf
Budding yeast – positive
Dengue NS1 antigen - positive
FINAL DIAGNOSIS
• ACUTE FEBRILE ILLNESS
• DENGUE FEVER WITH THROMBOCYTOPENIA
ASSESSMENT
Day 1 :
• Mrs. BS 37YOF had complaint of high grade fever since 3 days
with chills and body pains .
• There was decrease in her platelet count(60,000) and increase
in AST(70),ALT(61) . She was suspected to have Dengue fever . So
• IVF NS/RL 100ml/hr IV was given for hydration .
• Paracetamol 1g IV TID was given for fever .
DAY 2:
• TLC was increased slightly and urine examination showed
presence of proteins , leucocytes , pus cells (4-5/hpf) and
budding yeast which indicates presence of infection so
Inj . Ceftriaxone (antibiotic) 1g IV BD was given
Day 3:
• Positive result for the Dengue NS1 antigen test was seen
Hence dengue was confirmed
• IVF NS/RL 100ml/hr and paracetamol 1g IV TID was continued
• As Dengue fever was confirmed Ceftriaxone was discontinued
Patient had complaint of red spots at ankle joints on both legs so
Atarax 10mg stat was given
Tab . Zincovit 1 tab PO OD was also given as vitamin and mineral
supplement .
• Day 4 :
Fever subsided
Itching was present
Rash on hands and legs was present so
• Tab . Hydroxyzine 10mg TID and
• Inj . Pheniramine maleate 1 amp stat was given
• Day 5 :
Rash and itching did not subside so T . Fexofenadine 180mg
1 tab PO OD was given
• On day 5 and 6 slight increase in platelet count was seen
• Day 7 :
Platelet count increased from 68,000 to 1,21,000
Rash decreased
Afebrile
Patient was discharged .
DRUG CHART
BRAND
NAME
GENERIC
NAME
DOSE
ROUTE FREQ
USE /
CATEGORY
START
DATE
STOP
DATE
Inj . Monocef Ceftriaxone
1g
IV
Antibiotic
17/9
19/9
IVF NS/RL
100ml/ IV
hr
Hydration
17/9
20/9
Normal saline
Inj . Perfalgan Paracetamol
1g
BD
IV
TID
Fever
17/9
20/9
T . Zincovit
Zinc,Mn,FeVit 1 tab
A,E,B1,B2,B12
,B5,C,D3,folic
acid
PO
OD
MVT
19/9
23/9
T . Atarax
Hydroxzine
10mg
PO
TID
Itching
20/9
23/9
T . Allegra
Fexofenadine
180mg PO
OD
Itching
21/9
23/9
BRAND
NAME
GENERIC
NAME
DOSE
ROUTE
FREQ
USE
START
DATE
Inj . Avil
Pheniramine
maleate
1amp
IV
stat
Itching
20/9
PLAN
GOALS ACHIEVED
• decreased the body temperature
• increased the platelet count to 1,21,000
• Rash decreased
MONITORING PARAMETERS
• Disease monitoring parameters :
1.
2.
3.
4.
Monitor temperature pattern
Monitor volume of fluid intake and losses
Monitor WBC , platelet , hematocrit , LFT , sodium
Monitor for warning signs
• Drug monitoring parameters :
1.
2.
3.
4.
Paracetamol : LFT , RFT , sodium , calcium , glucose , Sr . Cr
Ceftriaxone : coagulation parameters , LFT , RFT
Atarax : ECG , mental status , B.P
Fexofenadine : RFT , monitor CNS effects
PATIENT COUNSELLING
• Fexofenadine : Do not take fexofenadine with
fruit juice (such as apple, orange, or
grapefruit) .
• Zincovit : one tablet after breakfast should be
taken .
LIFESTYLE MODIFICATIONS
• Plenty of fluids have to been taken .
• Adequate bed rest is required
PREVENTION
• The only way to prevent dengue fever is to avoid
being bitten by a vector mosquito.
• Use mosquito repellents containing DEET (N,Ndiethyl-3-methylbenzamide) .
• Remain in well-screened or air-conditioned places .
• Eliminate stagnant water .
DISCHARGE MEDICATIONS
BRAND NAME
GENERIC
NAME
DOSE ROUT
E
FREQ
INDICATION
DURATION
T . Zincovit
Zinc, Mn , Fe
Vit
A,E,B1,B2,B1
2,B5,C,D3,
folic acid
1 tab
PO
OD
After
food
MVT
10days
T.
Allegra180mg
Fexofenadine I tab
Po
OD
After
dinner
Rash
10days