Dr. Saumya Mittal
Internal Medicine
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
My uncle is 45 years has been running fever for the past six days which has been pretty much on/off. He has been having two febrile episodes with chills in the evening and early morning associated with generalized weakness. Apart from that, he has no other symptoms. He has already finished Azithromycin 500 mg OD for five days along with Dilo 650 mg sos and has now started Taxim O CV 200 (Cefixime and Clavulanic acid) BD since yesterday due to the persistence of fever. His vitals are all stable except for mild to moderate temperature, usually between (100- 103F). We ran a fever profile on him where CBC shows leukocytosis TLC 11300, ANC 7910, mild thrombocytosis (4.68), LFT shows elevated liver enzymes AST 131 U/L, ALT 93 U/L, alkaline phosphate 178 U/L, GGT 309 U/L, his dengue IgM is positive, IgG and NS1 are negative. His creatinine is also slightly elevated at 1.6 mg/dL. Other investigations, including malarial antigen (PF, PV) and widal, are negative. He does not have any other comorbidities. He does not want to visit the hospital, given the current COVID-19 situation. Kindly guide us further with the treatment.
Hello,
Welcome to icliniq.com.
I have read your message and reports (attachment removed to protect patient identity). The descriptions indicate that he seems to be suffering from dengue fever and maybe bordering on stage 2 of dengue, known as dengue hemorrhagic fever. I would first and foremost recommend admission irrespective of the COVID-19 status. He is going to need iv fluids and other injectable medicines and regular blood tests and monitoring. In the meantime, you can take tablet Pan 40 (Pantoprazole) twice daily, tablet Folvite 5 once daily, and tablet Paracetamol 500 thrice daily. Take plenty of fluids. Visit the ER immediately.
Patient's Query
Thank you doctor,
But why is his LFT deranged and creatinine elevated? Does he also need a hepatitis profile and USG abdomen? I will convince him to go to the ER. Do you want us to continue the antibiotic (Taxim O CV) or discontinue it? Can you elaborate on what other iv medications he would need, as my family is worried?
Hello,
Welcome back to icliniq.com.
Deranged LFT (liver function test) and KFT (kidney function test) can be deranged in severe dengue and infection. It is not usually appropriate to start further testing like the hepatitis profile or USG abdomen. But in that situation, regular monitoring is needed. Antibiotics can be continued since we have done only limited tests. IV antibiotics and other supportive iv medications may be needed. As I said before, get him admitted.
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Internal Medicine
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