A 5-year old female child was admitted with 4 days of fever and chills, vomiting, abdominal pain, and fast breathing. Based on lab tests showing decreasing platelet and white blood cell counts and increasing hematocrit, she was diagnosed with dengue with warning signs. She was treated with intravenous fluids, antipyretics, antibiotics, antiemetics, and probiotics. Her symptoms improved and she was discharged after her vitals stabilized and lab values started recovering.

1. Case presentation on dengue with
warning signs
Presented by :
METI.BHARATH KUMAR
16DK1T0014
Pharm-D(Intern)

2. DEMOGRAPHIC DETAILS
• NAME : XX
• AGE : 5yrs
• SEX : Female
• DEPARTMENT : Pediatrics
• Child Medical Ward II
• ADMISSION DATE : 21 september, 2021.
• ADMISSION NO: 50405
• Consultant physician : Dr Ravi krishna
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3. Subjective evaluation
A 5 year old female child admitted with chief
complaints of
• Fever with chills since 4 days not associated with
rash
• Vomiting 2 episodes
• Abdominal pain
• Fast breathing
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4. Objective evaluation
The doctor advise : CBP, Malarial Pasarite, Dengue, LFT
CBP 23-10-21 24-10-21 25-10-21 26-10-21 27-10-21 28-10-21
Hemoglob
in
12gm/dl 12.9gm/dl 15.5gm/dl 14.2gm/dl 12.5gm/dl 12.2gm/dl
RBC 4.15million
cells/mcL
4.78million
cells/mcL
5.84million
cells/mcL
5.28million
cells/mcL
4.59million
cells/mcL
4.36million
cells/mcL
WBC 5,800
cells/mcL
4,600cells/m
cL
5,400cells/m
cL
5,500
cells/mcL
6,400cells/m
cL
7,700cells/m
cL
PLT 1,00,000 67,000 40,000 23,000 36,000 50,000
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5. ASSESSMENT
Based on subjective and objective evaluation the patient is
diagnosed as dengue with warning signs
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6. Monitor vitals
VITALS 23-10-21 24-10-21 25-10-21 26-10-21 27-10-21 28-10-21 29-10-21
Blood
Pressure
110/70
mmHg
100/70
mmHg
90/70
mmHg
100/60
mmHg
100/60
mmHg
100/70
mmHg
100/60
mmHg
P/A soft soft Loose
stools
distended distended soft soft
SPO2 98% 98% 98% 97% 98% 96% 98%
Pulse Rate 102bpm 110bpm 110bpm 111bpm 120bpm 100bpm 110bpm
Respirator
y Rate
22/min 20/min 28/min 26/min 27/min 25/min 20/min
CRT < 3 sec < 3 sec < 3 sec < 3 sec < 3 sec
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7. Plan of treatment
 Tab Doxycycline 100mg BD 1-0- ½ (5 Days)
 Tab Paracetamol 500mg 1-1-1 (8 Days)
 Tab Pantop 40mg ½ -0-0
 Tab Ondansetron ½ -0-0
 Probiotics 1-0-1
 IVF- RL, DNS
 Tab Cefixime 200mg 1-0-1
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8. DAYS 23-10-21 24-10-21 25-10-21 26-10-21 27-10-21 28-10-21 29-10-21
SYMPTOMS Fever,
vomiting
Fever,
myalgia,
vomiting
Fever spikes
vomiting,
loose stools
5-6
episodes
Hepatomeg
aly
Vomiting,
abdominal
pain, fever
Abdominal
pain,
vomiting
Abdominal
pain
Abdominal
pain
ORS   X X   
T PCT       
T PANTOP   X X X X X
T
ONDANSETR
ON
  X X X X X
T DOXY      X X
INJ PANTOP X X     X
INJ VOMISET X X     X
IVF RL, DNS X X  DNS : X DNS : X X X
PROBIOTICS X X X   X X
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PATHOPHYSIOLOGY

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14. Probable dengue according to CDC
• Patient lives or travelled to dengue endemic area
.Patient also has fever and two or more of the
following clinical features
nausea,vomiting,rash,aches, tourniquet test
positive,leukopenia,any warning signs
warning signs:
abdominal pain or tenderness
persistent vomiting
clinical fluid accumulation
Mucosal bleed
Lethargy or restlessness
Liver enlargement
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16. diagnosis
 COMPLETE BLOOD PICTURE
 DENGUE KIT
 LIVER FUNCTION TEST
 ULTRASOUND ABDOMEN
 MALARIA KIT
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17. management
 There is no specific treatment for Dengue
 Oral rehydration therapy
 Intravenous fluids
 Plasma Rich Platelets Transfusion
 Symptom based Treatment
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