VOMITING ,ABDOMINAL PAIN,REDUCED PLATELET

55 year old female came with complaints of vomiting and abdominal pain for 1 day. She was apparently normal 4 days back,then she developed rapid onset high grade fever with chills and rigor.She was hospitalised and UTI was diagnose and treated accordingly..........She also developed frontal headache for past 2 days. She also complains of lower back pain She had excessive menstrual bleeding She is having uterine fibroid She is diabetic and have hypothyroidism and is on medication for both. No relevant travel history,family history. General examination: Patient is concious, cooperative,well oriented in time,place, person T=98.5°F Pulse=58 bpm RR=17/minute.,...Thoracoabdominal SpO2=97% Systemic examination: CNS:NFND CVS:S1,S2 + RS: NBAE GIT: Distended Dengue NS1 antigen ------( + ) Platelet count=57,000 Injection PANTOP 40 mg IV stat Injection EMESET 1 amp IV stat IVF Ringer Lactate 1 pint ECG taken.......Sinus bradycardia present,No other abnormalities detected GRBS=127 mg/dL ...........................

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Ecg reveals sinus bradycardia. Hr 50/mt.it is dengue fever with thrombocytopenia. Menorrhagia is because of thrombocytopenia. Pl have close watch on platelet count. May have to do twice daily. Inj vit k 10mg od for 3 days.if the platelet count drops below 20 thousand she may need platelet infusion. We see bradycardia routinely in all dengue fever pts

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Sinus bradycardia with prolonged QTC Need to compare with old ECGs Rule out Hypothyroidism , electrolytes imbalance Need to treat Dengue , as per protocol .

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S bradycardia Qtc prolonged Platelets r reduced WBC?? Dangue positive Admit pt in hospital Check platelets twice a day

S.Bradycardia Flattening of St segment in multiple leads Check S.K, S.Calicium level Hypokalemia /& Hypocalcemia

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Sinus bradycardia. Do cardiac enzymes testing to diagnose myocarditis. Most of cases improve spontaneously

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ECG sinus bradycardia,qtc prolonged. Otherwise nothing abnormal. Maintain hydration, BP, electrolyts.

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Continue IV fluids. Keep watch on platelets, hematocrit. Add injection Multivitamin.

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Send me xray chest. And TROP I blood test repeat ECG and checked widal test

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CHB Post viral myocarditis

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CHB ASK FOR PACEMAKER

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