Case presentation of dengue for Pharm.D students.

1. PHARMACOTHERAPEUTICS–2
Case presentation on Dengue with
thrombocytopenia
Presented To,
Dr.Swathy Suresh
Ast.Prof of Department Of Pharmacy
practices
Presented By,
K Mogeshwar
3rd Pharm D
PES3UG21PD037

2. Patient Demographics
o Name - ABC
o Gender - Female
o Age - 65 years
o DOA - 4/8/2022
o DOD - 9/8/2022

3. Subjective Evidences
Current complaints and history of present illness –
o C/O fever with chills since 5 days, associated with myalgia
and general weakness
o No H/O cold and cough / vomiting / loose stools / pain in the
abdomen
Past Medical History –
o K/C/O Type 2 DM since 6 years on Rx
o K/C/O HTN since 6 years

4. Subjective Evidences
Past Medication History -
o Pinom H 40 : 1-0-0
o Metaforte : 1-0-1/2
o Insugen N
o T. Ecospirin 75 mg : OD
o T. Avas : 0-0-1

5. Objective Evidences
Systems -
o Patient was conscious and oriented
o CVS : S1 S2 positive
o RS : B/L NVBS positive
o PA : Soft and non tender
o CNS : NAD
Other tests -
o Dengue NS1 Ag Positive

6. Objective Evidences
TESTS NORMAL VALUES DAY 1 DAY 2 DAY 3 DAY 4
Hb 13-17 g/dl 12.8 13.1 12.5
PCV 39-49 % 37
RBC 4.5-5.5M cells/cmm 4.7 M
MCV 76-100 fL 82
MCH 25-35 pg/cell 28
MCHC 31-35 g/dl 35
Platelet count 150-400K cells/cmm 54K 39200 38000 32750
TC 4K-10K cells/cmm 8160 7260 8110
Neutrophils 54-62 % 77 63
Lymphocytes 25-33 % 19 29
Eosinophils 1-3 % 1

7. Objective Evidences
TESTS NORMAL VALUES DAY 1 DAY 2 DAY 3 DAY 4
Monocytes 3-7 % 3 5
Basophils 0-1 % 0 1
RBS < 200 mg/dl 183
Blood urea 7-20 mg/dl 19
SGOT < 35 IU/L 188 83
SGPT 10-35 IU/L 132 93
GGT 7-51 IU/L 57 128
Sr. Creatinine 0.8-1.4 mg/dl 0.7
Sodium 135-147 mEq/L 126
Potassium 3.5-5 mEq/L 3.2
Chloride 95-107 mEq/L 96

8. Assessment
Based on Subjective and Objective evidence, the patient was
newly diagnosed with
* Dengue with thrombocytopenia
Diagnosis Subjective Evidence Objective Evidence
Dengue C/O fever with chills
since 5 days,
associated with
myalgia and general
weakness
Dengue NS1 Ag Positive; Anemia,
Thrombocytopenia, Increased Neutrophils
and Decreased lymphocytes, Elevated liver
enzymes; decreased Sr. creatinine
Hypokalaemia and Hyponatremia.
HTN and Type-2
DM
Past Medical and
Medication History
-

9. Plan - Treatment Goals
Short term goals -
o To reduce myalgia and weakness
o To reduce the elevated body temperature and chills
Long term goals -
o Eradication of the infecting organism, and management
of complications
o To maintain normal or near-normal glucose levels and
blood pressure
o To prevent long term complications of HTN and DM
o To improve quality of life

10. Plan – Current Medications
DENGUE Brand name Generic name Dose Freq ROA Days
Fever and Chills Inj. PCT Paracetamol 1 g 1-1-1 IV 6
Anemia Folicit Folic acid 5 mg 0-1-0 PO 6
Gastro-protectant Inj. PAN Pantoprazole 40 mg 1-0-0 IV 6
HTN
To manage HTN Olmeth Olmesartan 40 mg 1-0-0 PO 6
TYPE-2 DM
To manage DM Actrapid Regular Insulin Acc 1-1-1 SC 6
OTHERS
To prevent nausea
/ vomiting
Emeset Ondansetron 4 mg SOS IV

11. Plan – Clinical Progress
Day 1 -
o Adv - Admit in ward
o IVF NS @100ml/hr, medications as per the chart
Day 2 -
o Patient was feeling better, Tiredness decreased
o BP - 100/70 mmHg, PR - 72 bpm, O/E - Afebrile
o Monitor the platelet count

12. Plan – Clinical Progress
Day 3 -
o Repeat the platelet count and CBC
o BP - 120/80 mmHg, PR - 76 bpm
Day 4 –
o Patient was feeling better, Afebrile, no bleeding manifestation
o Temperature – 98.2
o Pulse – 82 bpm
o BP – 120/80 mmHg
o Adv : Repeat platelets, CBC
o LFT

13. Plan – Clinical Progress
Day 5 –
o No fresh complaints, Afebrile
o GRBS – 187 mg/dl
o Repeat platelets
o Stop IV fluids
Day 6 –
o No fresh complaints,
o No bleeding manifestations, Afebrile
o PR – 76 bpm, BP – 140/90 mmHg, Adv : Discharge
o GC – Fair
o Withhold T. Ecospirin till 13/8. Restart the tablet after the review.

14. Plan – Discharge Medications
DENGUE Brand name Generic name Dose Freq ROA Days
Fever and Chills Inj. PCT Paracetamol 1 g SOS IV 1 week
Anemia Folicit Folic acid 5 mg 0-1-0 PO 1
month
HTN
To manage HTN Pinom H 40 Hydrochlorothiazide +
Olmesartan
12.5 /
40 mg
1-0-0 PO To
Cont.
TYPE-2 DM
To manage DM Actrapid Regular Insulin Acc 1-1-1 SC To
Cont.
OTHERS
Prophylactic T. Avas Atorvastatin 10 mg 0-0-1 PO To
Cont.

15. Plan
Drug Class
Paracetamol Antipyretic
Folic acid Nutritional supplement
Hydrochlorothiazide +
Olmesartan
Thiazide diuretic / ARB
Regular Insulin Short-acting insulin
Atorvastatin HMG CoA reductase inhibitors

16. Plan - Patient Counselling
Disease Specific -
o Dengue - it is a viral disease transmitted by mosquitoes
that causes sudden fever and acute pain in joints
o Type 2 DM - A chronic condition that affects the way the
body processes glucose. With type 2 diabetes, the body
either doesn't produce enough insulin, or it resists insulin.
o HTN - A condition in which the force of the blood against
the artery walls is too high.

17. Plan - Patient Counselling
Drug Specific –
o Take your medication on time, don't skip them
o Folicit – Do not take more than what is prescribed
o Olmesartan – Avoid potassium rich foods like avocado,
sweet potatoes, apricots, salmon
o Insulin – Injection sites must be rotated between thigh,
abdomen, deltoid and gluteal regions. Inject it
subcutaneously. Take 15 mins before the meal. Do not
skip the meal after taking insulin

18. Plan - Patient Counselling
Lifestyle modification –
o Limit salt content in the diet
o Adopt DASH therapy - The DASH diet is rich in vegetables,
fruits and whole grains. It includes fat-free or low-fat dairy
products, fish, poultry, beans and nuts. It limits foods that
are high in saturated fat, such as fatty meats and full-fat
dairy products
o Consumption of papaya leaf extract increases the platelet
count
o Prevent stagnation of water at home or surroundings and
use mosquito nets and repellants
o Maintain hygienic environment

19. Plan - Patient Counselling
o Drink adequate amount of water to avoid dehydration
o Cover overhead tank to prevent access to mosquitoes
o Eliminate breeding ground by removing unused plastic pools,
old tires, or buckets
o Avoid walking barefoot, Stay away from sharp objects
o Engage in physical activity like walking

20. Plan - Patient Counselling
o Do not take any OTC medications to obtain relief from pain
(arthralgia and myalgia)

21. Plan
Pharmacist Intervention –
o Papaya leaf extract should be administered along with the
medications for added benefits. (Boosts platelet count by
increasing the activity of genes that are responsible for platelet
production). Eg – Caripill
o Renal Function Tests should be performed to evaluate the
kidney function and adjust the doses of the drugs
o LFTs have to be repeated after recovery from dengue, to
evaluate whether the elevation in the liver enzymes was
transient or not.

22. Plan
o Electrolytes should be repeated. If there is electrolyte
imbalance even after recovery from dengue, suitable
intervention is necessary.

23. THANK YOU