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Step 1: View clinicals

A 49 year old woman developed a high fever 5 days ago, in association with a retro-orbital headache, body aches, anorexia, and intermittent nausea and vomiting. The fever subsided last night, but the other symptoms still persist. She had returned home just 1 week ago, following a 3 week trip to Sri Lanka. Her medical and surgical histories are unremarkable, she does not smoke, and only drinks socially. There is no history of recreational drug abuse or unsafe sex.

Step 2: Order all relevant investigations

Full Blood Count

WBC: 4,000/mm3 (4,000 - 11,000) Hb: 11 g/dL (11 - 18) Hematocrit: 41% (36.1 - 44.3) Platelets: 18,000/mm3 (150,000 - 400,000)

Dengue IgM ELISA

The report will be available tomorrow.

ECG + Portable Echocardiogram

The ECG is significant for a rate of 100 bpm, with a sinus rhythm. No other abnormalities are noted. The echocardiogram shows normal myocardial contractility, and a left ventricular ejection fraction of 68%

Liver Function Tests

AST: 82 IU/L (10 - 34) ALT: 70 IU/L (10 - 40) ALP: 72 IU/L (44 - 147) Albumin: 4.0 g/dL (3.4 - 5.4)

Step 3: Select appropriate management

IV Crystalloids
Cardiac Inotropes
Platelet Transfusion
Disease Notification

Score: ★★☆