4 Conclusion and results:
Based on the patient’s medical history, symptoms, physical examination, and lab results, we diagnosed the patient with COVID-19 related Pneumonia along with Dengue Fever. Initially, the patient received hydration with intravenous Ringer’s lactate solution at a rate of 80 ml/h (total of 1920 ml) within the first 24 hours of admission before the lab reports were available. Treatment included starting Ceftriaxone 2 g daily and Ciprofloxacin 400 mg twice daily to address potential bacterial infections in COVID-19 cases. Additionally, Low Molecular Weight Heparin (Enoxaparin 60 mg subcutaneous injection twice daily) was initiated to prevent clotting issues associated with COVID-19. To manage stress ulcers, Injection Omeprazole 40 mg IV once daily was administered, along with Domperidone 10 mg three times daily before meals to reduce gastrointestinal disturbances due to the patient’s history of vomiting. To leverage their antiviral properties, Zinc 20 mg, Vitamin C 250 mg, Vitamin D 1000 IU, and Famotidine 20 mg were included in the treatment plan.
Following treatment, the patient experienced a bout of blood-vomiting within the initial 24 hours of admission and later developed a fever (one-time occurrence, without chills or shivering, temperature reaching 39 °C) during that period. The fever was managed with sponging and oral Paracetamol 500 mg (2 tablets at once). The fever resolved by the second day of hospitalization. The patient maintained good oxygen saturation levels and had uneventful breathing patterns throughout their stay. Intravenous fluid management was adjusted based on hematocrit levels for dengue management. Vital signs such as blood pressure, pulse rate, fluid intake-output, respiratory rate, and temperature were regularly monitored every 6 hours. The patient did not require oxygen therapy or steroids to prevent a cytokine storm. Upon discharge, the patient was afebrile, well-hydrated, and free from respiratory distress. They were advised to continue treatment at home isolation.