WBC going Down. And also platelet. Need your suggestions ...
H/ o fever? Gradual decrease of TLC with relative lymphocytisis. Rule in / out most common endemic disease in India - Typhoid fever, by doing Blood / Stool / Typhidot IgG and IgM - as you feel appropriate. Then consider other D / D. As HCT has increased 47.8 to 53.1 % in 24 hours, start iv fluid to combat dehydration. Start antibiotics considering Typhoid, and to combat opportunistic bacterial infection.
Platelet not significant decrease. First give IV fluids crystloids maintain vitals, pcm500mg sos.keep close observation. If patient is febrile, Repeat CBC, WIDAL&TEST FOR DENGUE.Leukopenia may occur in early stage of typhoid but ONLY rising titre widal is diagnostic for typhoid.Dengue test may remain neg intially. D/D 1.viral fever2. Dengue 3 Typhoid fever Treat accordingly & take physician reference.
It might be gradually decreasing or not significant at all...if there is a rapid reduction in plt or wbc with high grade fever headache arthralgia dengue serology can be done... If the fever pattern is High grade associated with chills and early morning episodes associated with GI symptoms widely can be done to rule out salmonella In both cases hydration is important and IV fluids has to be started along with symptomatic treatment ...which gives relief to the patient ...and the rest of the treatment can be decided based on repors
Sir give iv fluid as plt is good if no fever add dexa if fever don't give do widal test plt is going down but it is not 20%down
Treat it like acute fertile illess.need iv fliuid as PCV is increase
Do a clinical exsmination..look for rash (v.imp) lymphadenopathy, features of ards (rhonhi , creps , tachypnea), look for hepatoslenomegaly. Do a IgM dengue and IgM lepto, Peripheral smear for malaria If patient from near foreat area do a Ig M scrub typhus...
Do dengue igm igg ns1 tab caripill 1tds tab doxycycline 100 mg 1bd for 5days give plenty of I/V fluids tab paracetamol for fever
Many none dengue viral fevers present like this. Hydration & monitor vitals
Haematocrit is rising..immediately I.v. fluids(crystalloid) must be started irrespective of platelets and wbc count
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