Things not to miss - Dengue
A young girl presented with fever for 4 days duration in the evening to the casualty medical ward. She complained about few episodes of diarrhea and 2 episodes of vomiting. There was mild epigastric pain. Her younger brother also had a diarrheal illness about a five days back. She denied outside food consumption.
She was ill looking but the blood pressure was 110/80mmHg. Pulse rate was 104/min. House officer decided to give a pint of normal saline over 1 hour as she was not taking orally. He also ordered bifilac, oral rehydration solution and intravenous metoclopromide. He didn't start an antibiotic, but made a mental note to ask the registrar during the night ward round.
Three hours later he went to review the patient. She was still ill looking but the blood pressure was 80/60 mmHg. There had been one another episode of loose stools but the amount was little. He asked to give a pint of saline fast and called the registrar.
On examination the registrar detected bilateral pleural effusions and flank dullness. Her investigations were urgently traced
WBC - 1.24
Hb - 14.6
HCT - 54%
Platelets - 46
Diagnosis???
Dengue haemorrhagic fever with shock!
Lesson
~ Any patient coming with fever has dengue unless proven otherwise!
~ Keep dengue as a differential diagnosis for any febrile illness as it is very common and a few hours delay of proper treatment can be fatal.
~ Sometimes when the patients major problem is something else (eg: diarrhea or vomiting) they might forget to mention the history of fever! Don't be misled by contact history like in this patient. Her brother would've had something else, or dengue fever without going into leaking phase.
~Always examine all 4 systems with a conscious mind. You won't get a flank dullness or an effusion unless you look for it!
Homework
~ Read about the pathophysiology of the dengue, unless you know the pathology you will never understand the rationale behind the treatment protocols.
~ Read the dengue guidelines and be thorough with the management of dengue shock.
~ Read about the unusual manifestations of dengue. Remember, when a disease is common, uncommon manifestations become common!
She was ill looking but the blood pressure was 110/80mmHg. Pulse rate was 104/min. House officer decided to give a pint of normal saline over 1 hour as she was not taking orally. He also ordered bifilac, oral rehydration solution and intravenous metoclopromide. He didn't start an antibiotic, but made a mental note to ask the registrar during the night ward round.
Three hours later he went to review the patient. She was still ill looking but the blood pressure was 80/60 mmHg. There had been one another episode of loose stools but the amount was little. He asked to give a pint of saline fast and called the registrar.
On examination the registrar detected bilateral pleural effusions and flank dullness. Her investigations were urgently traced
WBC - 1.24
Hb - 14.6
HCT - 54%
Platelets - 46
Diagnosis???
Dengue haemorrhagic fever with shock!
Lesson
~ Any patient coming with fever has dengue unless proven otherwise!
~ Keep dengue as a differential diagnosis for any febrile illness as it is very common and a few hours delay of proper treatment can be fatal.
~ Sometimes when the patients major problem is something else (eg: diarrhea or vomiting) they might forget to mention the history of fever! Don't be misled by contact history like in this patient. Her brother would've had something else, or dengue fever without going into leaking phase.
~Always examine all 4 systems with a conscious mind. You won't get a flank dullness or an effusion unless you look for it!
Homework
~ Read about the pathophysiology of the dengue, unless you know the pathology you will never understand the rationale behind the treatment protocols.
~ Read the dengue guidelines and be thorough with the management of dengue shock.
~ Read about the unusual manifestations of dengue. Remember, when a disease is common, uncommon manifestations become common!
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