50 year old male with fever and lethargy

 THIS IS AN ONLINE E LOG BOOK TO DISCUSS OUR PATIENT'S DE - IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS / HER /GUARDIAN'S SIGNED INFORMED CONSENT .HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS WITH AN AIM TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUT .


50 year male Farmer by occupation came with chief complaints of
Fever since 10 days
Lethargy since 4 days 
SOB since 2 days
Patient was apparently alright 10 days back then he had low grade fever  relieved on taking medication . Not associated with chills and rigors and doing his routine works , from 4 days as patient was lethargic and taken to local hospital found out to be: 
Dengue NS 1 + and platelet count was 44,000
-From 4 days patient also complaints of cough.

PAST HISTORY :
Not known case of DM2 , Hypertension , Asthma , TB , Epilepsy .

PERSONAL HISTORY :
Diet- mixed
Appetite- normal
Sleep- adequate
Bowel and bladder movements- regular
Addiction : toddy consumption 3-4 times a week

FAMILY HISTORY: 
Not significant

GENERAL EXAMINATION:
No Pallor 
No icterus, cyanosis, clubbing, koilonychia, lymphadenopathy, edema

VITALS AT ADMISSION :
Temp.- Afebrile
PR- 55 bpm
RR- 40cpm
BP- 130/70 mmHg
SpO2- 98% at RA 
GRBS- 138mg/dl

SYSTEMIC EXAMINATION:
CVS: S1S2 heard, no murmurs
RS: BAE+ NVBS+
P/A: Soft, Non-tender
CNS: NAD







PROV DIAGNOSIS : 
Server ARDS with Dengue NS 1 reactive with Thrombocytopenia . ( H/O 1 SDP and 1 FFP transfusion )

TREATMENT : 
1. IVF NS , RL @ 75 ml/hr
2. Daily postural BP monitoring
3. W/F Bleeding manifestation
4. I/O strict monitoring




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