TWO WORDS FOR YOU, A
HUGE RELIEF FOR THEM
A 65-year-old lady, with a five day
history of fever, was referred to our
hospital, in view of positive Dengue IgM
and deranged renal functions.
Leptospira IgM tested at the referring
hospital was negative. She also
complained of vomiting, loose stools,
generalized tiredness and body ache.
She did not give any history of
co-morbidities except for a thyroid
swelling for which she took medicines for
some time and then stopped by herself
years ago.
On examination, she was febrile and a
diffuse thyroid swelling of about 5 x 3
cm was noted. Rest of the examination
was normal at the time of admission.
Relevant blood investigations were
done. Her blood counts and thyroid
functions were found to be normal. She
was admitted to our ward.
She was accompanied by her husband,
who worked earlier as a tailor and is
currently not working. Their only
daughter had moved out with her
husband.
She was managed symptomatically for
dengue fever. A strict intake-output chart
was maintained and serial renal function
tests were monitored. In spite of the
illness, she and her husband were both
happy and satisfied. They welcomed us
with warm smiles, every morning and
evening, when we used to go for rounds.
On day 5 of admission, the husband
said that he noticed his wife was
becoming breathless after going to
toilet. On examination, she was found
to have irregularly irregular pulse,
hypotension, tachypnea and basal
crackles in the chest. ECG showed atrial
fibrillation. We explained in detail to
both the patient and the bystander that
the patient is going into a critical
condition and she needs intensive care
unit admission.
Dr. Rahima Ali Ebrahim
2nd year DNB Resident,
Department of Family Medicine,
Lourdes Hospital Post Graduate
Institute of Medical Science and
Research, Ernakulam
She was immediately shifted to ICU.
Nephrology and Cardiology opinions
were sought. Echocardiogram was done,
which showed no clots or abnormal
function. Injection furosemide was
started in view of probable pulmonary
oedema.Injection amiodarone was
given. DC cardioversion was also
advised by the cardiologist. Throughout
this course, we sat with the patientʼs
husband and counselled him. He was
initially confused, as would any layman
be. His wife was admitted here for
dengue fever, and she was not even
known to have hypertension or diabetes
mellitus, let alone any cardiac problem.
He listened patiently and was convinced
regarding the need for these treatment
procedures.
We attempted to revert the AF by cardio-
version, but unfortunately it was unsuc-
cessful. At this time, we also started to
get a little worried. But we made a
special effort in comforting both the
patient and her husband. Their daughter
could not travel back home. She made
numerous calls to her father in a day.
Since we kept our patientʼs husband well
informed and negotiated our plans with
him, he was convinced. He told us that
he could comfort his anxious daughter.
They trusted us. And we told them to
keep praying.
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