A 16 year old male presented with fever and epistaxis

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 A 16 year old male patient, student, was brought to casualty with chief complaints of bleeding from nose since 4 days and fever since 4 days.

HISTORY OF PRESENTING ILLNESS:

Patient was apparently asymptomatic 4 days back and then he developed fever which was high grade, continuous type and associated with chills and rigors. It was relieved temporarily on medications. Patient also had bleeding from nose since 4 days, recurrent type, occurring 2-3 times per day, each episode lasting for 1 hour. Patient also has headache and body pains (back ache*) since two days. Patient has a history of nose bleeding since last 5 years but did not get treated for it.  

No history of cold, cough, vomiting. 

PAST HISTORY:

No similar complaints seen in the past. Patient is not a known case of Diabetes, Hypertension, Tuberculosis, Asthma, Epilepsy, CVD. 

FAMILY HISTORY:

No similar complaints seen in family.

PERSONAL HISTORY:

Diet is mixed, appetite is normal, sleep is adequate, bowel and bladder movements are regular. No known allergies. Non smoker and does not consume alcohol. Not any kind of medications.

 

GENERAL EXAMINATION:

Patient is conscious, coherent and cooperative. Well oriented to time, place and person. Moderately built and moderately nourished. 

There is no pallor, icterus, cyanosis, clubbing, lymphadenopathy and edema.

Vitals --- BP: 110/70 mmHg    PR: 89 bpm    Temp: afebrile   RR: 18 cpm

 

SYSTEMIC EXAMINATION:

Cardiovascular: S1, S2 heard; no murmurs   Respiratory: NVBS + BAE+   CNS: NAD     P/A: Soft, non tender. 

PROVISIONAL DIAGNOSIS: 

Dengue fever..? 

INVESTIGATIONS:

MANAGEMENT:

I.V fluids- NS & RL for 75ml/hr

T. pan 40mg po/od

Temp monitoring fourth hourly..

Vitals monitoring