Dengue Fever

A 28 year old male presented to OPD on 27.09.2020 with complaints of high grade fever accompanied with headache and a generalised body ache since 27th morning. He also adds from 27th till today 30.09.2020 about the pain abdomen and feeling nauseated most of the day. 27th investigations attached On 27th, we had started him on ceftriaxone plus oflox 12 hourly On 29th September, upon fever not getting subsided we did Dengue test and NS1 came out to be positive Chief Complaints The main complaints debilitating for him are pain abdomen accompanied with nausea and a generalised body ache Vitals He has had fever in the range of 102.1 F, but today morning it was 99 F BP 110/80 Pulse 70 Management My concerns are - 1) I am advising him IVF DNS with optineuron infusion @ 100ml/hr in morning and IVF RL @ 100ml/hr in evening and during the day time I have advised him to take plenty oral fluids which includes ORS, fruit juices and so on. Is it wise what I am following considering his PCV? 2) Regarding pain abdomen, nausea and for generalised well being, what can be advised? I am already giving perinorm 24 hourly and pantop 12 hourly. For analgesia, is something safe besides PCM? Can Levosulpiride be advised 25mg TDS? 3) His Platelets are going down today which is the natural course of disease, I have started him on Caripill TDS since yesterday only. Anything else needed? 4) I have seen a lot of doctors giving lumerax 80 to dengue NS1 positive? Any rationale behind it?

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Obviously a c/o dengue fever a d you are on correct line of treatment Your concern About platelets going down 1 volumic dilution do show such results hence excessive iv infusion is ont wise 2 disease may not be in control hence decrease in plt so if you see any hemorrhage i e advancing stage 3 or 4 Keep pt in icu with platelets ready to transfuse to avoid dengue shock syndrome 3 concern rational of Lumirex yes positive results are seen with artisunate 60mg bd that bring fever under control and stops further fall of platelets 4 iv steroids inj dexamethasone to increase platelet count

Thanx dr Manoj Kumar
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Advise covid 19 test also bcoz cross reactivity can be seen

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You arebin the right tract of treatment with the pt with dengue where NS1 is positve Keep the hydrated but donot make over hydrated Keep watch on platelet count and any haemorrhagic manifestation and keep Platelet ready for transfusion as on when required Pt feeling debilatating is due to the viral infection Rest treatment go for symptomatic USG if abdomen tobexclude any other patholhy of pain abdomen

Advice Rapid Antigen Test and HRCT Give inj Falcigo 120 BD Along with Tab Carypapya 500 BD with Antacid

Like lumetrax.. Inj chloroquine also improves falling platlate / alters course of desease.....

Advise D dimer, S ferritin, CRP and LDH

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