9 yr old male child brought by mother with C/o fever since 3 days high grade, intermittent associated with chills ,relived by medication,to resume again, associated with frontal headache C/o abdominal pain since yesterday evening periumbilical region, crampy type,not with food intake ,non radiating, not as so with urination ,relived by medication, Since fever persisted &h/0 pain abdomen H/o decreased urine output ,h/o reduced fluid intake , c/o weakness & decreased appetite since 3 days . Gpe Hr:102 bpm, bp is 98/ 60 mmhg Rr:24 cpm Cft:<2sec Temp:37.8 degree c No pallor Nose:b/l hypertrophy of terminated peasant,throat:mild congestion, dental caries+ Lower limbs thickened oedema peasant P/a -soft ,tenderness peasant over rt epigastric ,preclinical,liver palpable 1.5 cm,liver span 6.5 cm Cns- power 3/4 both upper & lower limbs how to approach to patient basic inv been sent

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stool normal? usg of abdomen done? Urine RME? Stool RME?

usg abdomen shows hepatic periportal cuffing & cystitis rue : pale yellow,albumin -nil,plenty of pus cells/hpf ,sugar -nil,1-2 rbc/hpf,2-3 epithelial cells.
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one should do urine routine to see any proteinuria as oligouria m pedal edema is present. dds - dengue complicated typhoid APGN

seems like viral illness....w/f thrombocytopenia and s/o dhf,, dss.if hemodynamically he s stable do the conservative management.

It's a Viral illness manage it with symptomatic treatment.... Watch for BP and shock.....

history seems like viral illness with edema s/o capillary leak

Although blood urea goes against. ...need to rule out HUS. .

diagnosed as dengue with warning signs in critical phase

platelets should be monitored alt. day till recovery

in dengue platelet should pe less during capillary leak phase. but here platelet is normal.
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seems like viral infection conservative treatment

Dengue like illness rx conservative

dengue ns1 -reactive im & ig -non reactive
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