CASE PRESENTATION ON

DENGUE
BY
P. PRIYANKA
PHARM-D 5 th YR
Dengue fever: An acute mosquito-borne
viral illness of sudden onset with
headache, fever, prostration, severe joint
and muscle pain, swollen glands
(lymphadenopathy), and rash. The
presence of fever, rash, and headache (the
'dengue triad') is characteristic.
Symptoms

When symptoms do occur, they usually

begin four to 10 days after you are bitten
by an infected mosquito. Signs and
symptoms of dengue fever most
commonly include:
Fever, as high as 106 F (41 C)
Headaches
Muscle, bone and joint pain
Pain behind your eyes
Complications

Ifsevere, dengue fever can damage the

lungs, liver or heart. Blood pressure can
drop to dangerous levels, causing shock
and, in some cases, death.
Risk factors

Factors that put you at greater risk of developing

dengue fever or a more severe form of the disease
include:
Living or traveling in tropical areas. Being in
tropical and subtropical areas increases your risk of
exposure to the virus that causes dengue fever.
Especially high-risk areas are Southeast Asia, the
western Pacific islands, Latin America and the
Caribbean.
Prior infection with a dengue fever virus. Previous
infection with a dengue fever virus increases your risk
of having severe symptoms if you're infected again.
Causes

Dengue fever is caused by any one of

four dengue viruses spread by mosquitoes
that thrive in and near human lodgings.
PATHOPHYSIOLOGY
dengue virus invasion

antibody formation

reinfection

Augmentation of virus multiplication

Increased vascular Reduced platelets

permeability
Plasma leakage Coagulopathy

Hypovolemia Disseminated
intravascular
coagulation

Shock Severe
bleeding
DEATH
DEMOGRAPHIC DETAILS
Patient name : XY Age : 1yr

Sex :M Dept : paed

Unit :C Weight : 5.38 kg

DOA : 13/8/16
Reason for admission
•H/O fever since 2 days
• H/O of convulsions 1 episode
•H/O of developmental delay

Hisrory of present illness

•Patient was apparently alright before 2 days, then he
developed fever, mild to moderate degree,not
associated with chills or rigors
•H/O of convulsion 1episode lasting for 5
min,generalised tonic clonic type. H/O of uprolling of
eyes present
•H/O of drowsiness, irritatability since 2 days
•H/O of rash all over the body,not progressive.
 Provisional diagnosis :

? Dengue fever
with no warning signs with
seizures
 Laboratory data
•Hemoglobin : 9.5 g/dl
•WBC : 10,100cells/ cu mm
•RBC : 3.2 millions/ cu mm
•PLATELET: 58000 cells/ cu mm
•IMPRESSION: NORMOCYTIC HYPOCHROMIC
ANEMIA WITH THROMBOCYTOPENIA

Dengue tests:
• NS1AG +ve
• IgM weakly +ve
Weil felix test:
+ve 1:160 OXK
+ve 1:180 OXZ
Sr.electrolytes:
sodium:139 mEq/L
potassium: 3.7 mEq/L
calcium: 101.0 mEq/L
Urine routine:
pus cells:1-2 cells/hpf
 TREATMENT CHART
Sl. drug dose route frequency 1 2 3 4
no

1 IVF RL 16ml/ IV Y Y Y Y
hr
2 INJ.XONE(ceftri 200mg IV BD Y Y Y Y
axone)
3 SYP . Pacimol 3 ml p/o TID Y Y Y Y
4 INJ.ACILOC(ran 0.5cc IV BD Y Y Y Y
itidine0
5 INJ.ENCORATE 100mg IV BD Y Y Y Y
(sodium f/b
valproate) 50mg

6 INJ.LOPAZ(loraz 0.25cc IV SOS Y Y Y N

epam)
7 INJ.CHLORAM 125mg IV QID Y Y N N
PHENICOL
 DAY 1
SYSTEMIC EXAMINATIONS
 RS : AEE, no added sounds
 CVS : S1,S2 heard
 P/A : soft, non tender, mild hepatomegaly
 Temp : 100 degree F

O/E :
HR: 150 bpm
pulse +++/++
pallor +
macular rashes all over the body and face
 DAY 2

 PULSE- 130bpm
 O/E :
2 fever spikes > 99◦F
rashes reduced
mild hepatomegaly
PLT : 65,000

TREATMENT :
 AS PER CHART
 DAY 3
SPO2- 100%
PULSE- 130bpm

O/E : no fever spikes

RS : AEE
Rashes reduced
NFC

TREATMENT :
STOP: INJ.CHLORAMOPHENICOL 125mg
AS PER CHART
DAY4
Pulse:120bpm
No fever spikes
B/L AEE
GC: fair
P/A: soft ,mild hepatomegaly
PLT : 72,000
TREATMENT:
STOP: Inj.encorate 50mg BD
AS PER CHART
PHARMACEUTICAL CARE PLAN
•Subjective evidence:
•H/O fever since 2 days
• H/O of convulsions 1 episode
•H/O of developmental delay
•Pallor+ve
•Maculoar rashes all over the body and face

Objective evidence :
• Hemoglobin : 9.5 g/dl (13.5-17.5)
•WBC : 10,100 cells/ cu mm (4,500-10,500)
•RBC : 3.2millions/ cu mm (4.6-4.8)
•PLATELET: 58000 cells/ cu mm (150,000–450,000)
Dengue tests:
NS1AG +ve .IgM +ve
 urine routine:
pus cells: 1-2 cells/hpf
 weil felix test: +ve
Assessment :

By observing subjective and objective

evidences final diagnosis was made as
DENGUE FEVER
Planning :
Goals of treatment:

1) To recover from signs and symptoms

2) To initiate early and appropriate treatment
3) To prevent disease progression and further
complications
4) to treat for convulsions
Pharmacist intervention
Ringer lactate + ceftriaxone sodium:
concurrent use ceftriaxone and selected
IV calcium salts may result in formation
of ceftriaxone calcium precipitates and is
contraindicated in neonates.
Hence in children infuse ceftriaxone after
flushing the IV line with normal saline
before infusing RL
Monitoring parameters
BP
Serum electrolyte
CBC
Platelet count
Hematocrit
Vital signs
Peripheral perfusions
Organ function
Prevention

Stay in air-conditioned or well-screened housing. The

mosquitoes that carry the dengue viruses are most active from
dawn to dusk, but they can also bite at night.
Wear protective clothing. When you go into mosquito-infested
areas, wear a long-sleeved shirt, long pants, socks and shoes.
Use mosquito repellent. Permethrin can be applied to your
clothing, shoes, camping gear and bed netting. You can also buy
clothing made with permethrin already in it. For your skin, use a
repellent containing at least a 10 percent concentration of DEET.
Reduce mosquito habitat. The mosquitoes that carry the dengue
virus typically live in and around houses, breeding in standing
water that can collect in such things as used automobile tires.
Reduce the breeding habitat to lower mosquito populations.
LIFE STYLE MODIFICATIONS
drink plenty of fluids to avoid
dehydration from vomiting and high
fever. 
Avoid pain relievers that can increase
bleeding complications — such as aspirin,
ibuprofen (Advil, Motrin IB, others) and
naproxen sodium (Aleve, others).
Monitoring of electrolyte balance.
Sanitisation of surroundings.