Ever since I got the opportunity to work in the ER, I have decided to save the interesting cases on my blog for future references. Here’s one case that needs further discussion.
Female around her mid thirties presented to the ER with a three day history of acute watery diarrhea with multiple episodes of non-projectile vomiting. She was admitted in a local hospital where she received IV fluids and her routine labs showed increased Creatinine level with normal urea counts. On the third day, she started to develop rashes which where mostly predominant on the feet and legs and had a distal to proximal presentation. The rash was papule like, non-tender and not itchy. Her drug history showed that she denied any medication in the previous hospital. She is non-diabetic and non-hypertensive and no use of any drugs with the exception of omeprazole. No history of alcohol abuse and smoking. She is Multigravida with normal menstrual cycles and LMP was few weeks prior to consult. On Examination she was anemic with IV Canula in Situ. Her systemic findings were unremarkable. Her current urine output and input could not be assessed as she had no proper recording prior. Her diarrhea frequencies has decreased and now she had concerns about the rash. Her labs were sent and found that she had a low platelet count, around thirty thousand in amount with normal TLC counts. She was also positive for antibodies to Dengue, APPT was prolonged with a normal INR and creatinine levels were increasing since the last lab reports. Her routine urine examination showed plenty erythrocytes with Pus cells amounting to be less than 2/HUFF. Her D-Dimer was positive with a increase to around 1.7 mg/L. Her serology was negative.
A) What is your Plan?
B) What can be done to prevent further platelet fall?