Clinical Cases

A Case of Dengue Hemorrhagic Fever, Pleural Effusion and Acute Kidney Injury

Hemorrhagic Fever, with Pleural Effusion and Acute Kidney Injury is treated homeopathically in a hospital setting.

(Homoeopathic Assistance in ICU of leading specialty hospital of North India)

Patient : Mr. J. S., aged 18 years, being declared at the verge of death in ICU of a leading Hospital of North India after attack of Dengue Hemorrhagic Fever leading to uncontrolled hemorrhages and acute kidney injury was put on Ventilator Support after pleural pffusion and hypovolaemic shock.

We see how it feels when Phosphorus takes the place of Heparin, Serum anguillae replaces Lasix, Ventilator Support substituted for Antimonium tart and coma is prevented by Opium. We see how it feels when a multi-specialty expert team of Allopathic Physicians salutes Master Hahnemann’s science.

D.O.A (at *** Hospital, Ludhiana) : 14th October, 2010

Case C.R.No. (*** Hospital, Ludhiana) : ****6677

D.O.A (at Dr.Bindra’s and Cardio Life Care) : 18th October, 2010

Case C.R.No. (at Dr.Bindra’s and Cardio Life Care) : 1796-DB-04573/2010

CHIEF COMPLAINTS at Time of Admission to *** Hospital (14.10.2010)

High grade Fever since last 4 days

Chills with Body pains since last 4 days

Pain in/over eyes since last 3 days

Nausea since last 3 days

Rashes over Skin since last 3 days

Loss of appetite since last 3 days

H/O CHIEF COMPLAINTS

Patient was brought to *** Hospital, Ludhiana at 11.30 pm (14.10.2010) with complaint of High grade fever and chills with severe body pains for last 3-4 days. As symptoms like high grade fever, chills, body pains, pain over eyelids and rashes over skin with nausea pointed out the case as Dengue Fever, patient was advised admission in Emergency for next 24 hours observation and some lab investigations.

DRUG HISTORY

Since 1st Day of Fever to 14.10.2010

Patient was given Paracetamol for fever, Emset for nausea, Ibuprofen for pains and fever as well along with a few home remedies for fever or suspected Dengue Fever.

IV Fluid Transfusion

Analgesics and Antipyretics

Laboratory Investigations (*** Hospital, Ludhiana)

14.10.2010

Dengue Serology IgM Test : POSITIVE

Platelet Count : 1,23,000 /cmm

HgB : 11.2 gm%

Renal Function Test : Normal Limits

Liver Function Test : Normal Limits

BEGINNING OF EMERGENCY CRISIS

17.10.2010

Chief Complaints:

Decreased Urine Output (200 ml/24 hr)

Pain in Lower Back and Loins

Weakness and Lethargy

Laziness

Nausea and Vomiting

Advised CBC, RFT and ordered to shift to Nephrology Ward

18.10.2010

Platelet Count : 11000 /cmm (Eleven thousand)

HgB : 8.5 gm%

Blood Urea : 124 mg/dl

Serum Creatinine : 6.9 mg/dl

Patient was moved to Nephrology ward after diagnosis of Acute Kidney Injury (Acute Renal Failure) and it was planned to give diuretics as urine output was falling drastically.

18.10.2010

Chief Complaints:

Hemorrhages from IV sites

Hemorrhages from Oral Aphthous ulcers

URINE OUTPUT NIL (ANURIA)

Confusion of Mind and Semi-conscious state.

Patient was ordered immediately transfer to ICU 2 and advised SDP (single donor platelets) transfusions and dialysis was planned after Transfusion of SDPs.

HOMOEOPATHIC INTERVENTION

18.10.2010 (7 pm)

Patient’s father called us and asked to help in this crucial stage as patient’s condition was worsening by each hour and they were not in favor of carrying out dialysis on their son.

I visited the Nephrology ward and studied records of the patient and talked to the Assistant Professor of the Nephrology Department about their prognosis. His words were slightly bitter but clear that the patient was very sick (almost at the verge of death) and now only God could save him…” but still we will try our best”.

As case had worsened to a very advanced critical stage, I requested the father of the patient to let them (*** Hospital Doctors) transfuse SDP’s and carry out dialysis because we cannot do anything in a few hours or overnight. I assured him of our best efforts to save his son.

Chief Complaints/Signs and Observations: (after my visit)

Hemorrhages from IV sites and Oral Aphthous ulcers

URINE OUTPUT NIL (ANURIA)

Confused state of Mind and Semi-conscious state.

Sleepiness and Stupor.

Frightful in Sleep (weeping and screaming 1+)

PHYSICAL EXAMINATION

Pulse : 78/m

B.P : 110/70 mmHg

Temp. : 101 degrees F

R/R : 26/m

CVS Exam : S1 S2 Normal, No added sounds.

Lower Extremities pitting oedema++.

P/A NAD.

Chest B/L crepts ++

Impaired Intellect and Behavior, Confused state of mind (Pre Comatose)

PRESCRIPTION:

OPIUM CM – 1dose STAT (18.10.2010 10.30 PM)

19.10.2010 (8.30 pm) – [PATIENT WAS Transferred to ICU 2]

DIALYSIS 1 – Performed 2:30 am 19.10.2010 (4 hours)

TRANSFUSION – 3 SDP’s in last 24 hours

After almost 20 hours after OPIUM CM, patient was re-examined and case was evaluated again. Although patient was out of the pre-comatose state, his condition was worsening due to hemorrhages from nose, IV sites and oral apthous ulcers. Blood Pressure was falling due to hemodynamic instability and urine output was almost nil.

Chief Complaints/Signs and Observations: (after my visit)

OUT OF PRE-COMATOSE, much active and conscious as compared to previous day.

Hemorrhages from IV sites, Nose and Oral Aphthous ulcers

URINE OUTPUT NIL (ANURIA)

Confused state of Mind and Semi-conscious state.

Pain in Loins and back.

Nausea and Vomiting.

PHYSICAL EXAMINATION

Pulse : 80/m

B.P : 100/64 mmHg

Temp. : 104 degrees F

R/R : 24/m

CVS Exam : S1 S2 Normal, No added sounds.

Lower Extremities pitting oedema+++.

P/A NAD.

Chest B/L crepts ++

LAB INVESTIGATIONS

Blood Urea (after dialyisis) : 92mg/dl

S.Creatinine (after dialysis) : 5.2 mg/dl

Platelet Count : 27,000/cmm (AFTER 3 SDPs)

PRESCRIPTION:

PHOSPHORUS 0/1 Oral – Hourly (19.10.2010 – 9.30 PM)

After written consent by patient’s father, attending homoeopath (me), gave details of the homoeopathic medicine prescribed and finally Head of Department of Nephrology of*** Hospital allowed patient’s father to visit ICU at night, every hour to administer homeopathic medicine without any interference of the ICU staff.

20.10.2010 (2.30 pm)

DIALYSIS 2 – Performed 4:30 am 20.10.2010 (6 hours)

TRANSFUSION – 2 SDPs in last 24 hours

After almost 14 hours of repeated administration of PHOSPHORUS 0/1 orally, hemorrhages from oral ulcers were under control, but there was no improvement in IV sites and nasal hemorrhages.

Chief Complaints/Signs and Observations:

Hemorrhages from IV sites, Nose

Oral Aphthous ulcers Hemorrhages slightly under control

URINE OUTPUT NIL (ANURIA)

Temperature shot up with chills and shivering after our medicines at night which wasn’t getting down even with high doses of Anti-pyretics. (This was a sign of hope for us, but an alarming sign as well.)

PHYSICAL EXAMINATION

Pulse : 78/m

B.P : 110/70 mmHg

Temp. : 105.6`F

R/R : 22/m

CVS Exam : S1 S2 Normal, No added sounds.

Lower Extremities pitting oedema+++.

P/A NAD.

Chest B/L crepts +++

LAB INVESTIGATIONS

Blood Urea (after dialyisis) : 106mg/dl

S.Creatinine (after dialysis) : 4.9 mg/dl

Platelet Count : 26,000/cmm (AFTER 2 SDPs)

PRESCRIPTION:

CONTINUED – PHOSPHORUS 0/1 Oral – Hourly (20.10.2010 – 3.00 PM)

21.10.2010 (8.30 pm)

DIALYSIS 3 – Performed 10.30 am 21.10.2010 (4 hours)

TRANSFUSION – 2

After almost 50+ hours of repeated administration of PHOSPHORUS 0/1 orally, now the Hemorrhages from IV sites, oral ulcers and nose were under 30-40% control and this was enough for us to continue with Phosphorus as a ray of hope that had finally knocked at our door.

This % was calculated by ICU RMO as they were changing the gauze Bandages every 30- 45 minutes on the previous day, but since last night onwards gauze was being changed after almost 60-80 minutes and this was a big sigh of relief for them.

Chief Complaints/Signs and Observations:

Hemorrhages from IV sites, Nose and Oral Aphthous ulcers Hemorrhages 30-40% under control.

URINE OUTPUT NIL (ANURIA)

Temperature coming down after 12 hours and now there were no chills and shivering.

DIFFICULTY IN BREATHING (Oxygen Mask Support Given)

PHYSICAL EXAMINATION

Pulse : 82/m

B.P : 110/70 mmHg

Temp. : 102`F

R/R : 20/m

CVS Exam : S1 S2 Normal, No added sounds.

Lower Extremities pitting oedema+++.

P/A NAD.

Chest B/L crepts +++

LAB INVESTIGATIONS

Blood Urea (after dialyisis) : 82mg/dl

S.Creatinine (after dialysis) : 4.4 mg/dl

Platelet Count : 32,000/cmm (AFTER 2 SDPs)

PRESCRIPTION:

PHOSPHORUS 0/2 Oral – Hourly (21.10.2010 – 8.30 PM)

PATIENT WAS SHIFTED TO VENTILATOR SUPPORT LAST NIGHT DUE TO DIFFICULTY IN BREATHING.

VENTILATOR MODE – SIMV i.e. Synchronous Intermittent Mandatory Ventilation (NON-INVASIVE, FACIAL MASK)

After telephone report by patient’s father about Ventilator Support System, medicine administration method was shifted to applying on clean skin surface on any part of body.

22.10.2010 (3.30 pm)

TRANSFUSION – NO SDP in last 24 hours (For the 1st time since last week)

After repeated administration of PHOSPHORUS 0/2 on skin surface, now the hemorrhages from IV sites, Oral Ulcers and Nose were under 70% control and for the first time in last 7 days, there was no transfusion of SDP’s today.

This % was calculated by ICU RMO as they were changing the bandages every 60- 80 minutes on last day but since last night onwards Bandages were being changed after almost after every 2 hours or even more.

Chief Complaints/Signs and Observations:

Hemorrhages from IV sites, Nose and Oral Aphthous ulcers Hemorrhages 70% under control.

HEMATURIA

URINE OUTPUT 100 ml/24 hours (ANURIA)

PHYSICAL EXAMINATION

Pulse : 77/m

B.P : 100/70 mmHg

Temp. : 101 degrees F

R/R : 18/m

CVS Exam : S1 S2 Normal, No added sounds.

Lower Extremities pitting oedema+++.

P/A Tenderness.

Chest B/L crepts +++

LAB INVESTIGATIONS

Blood Urea (after dialyisis) : 88mg/dl

S.Creatinine (after dialysis) : 4.7 mg/dl

Platelet Count : 46,000/cmm (NO SDPs)

PRESCRIPTION:

PHOSPHORUS 0/2 On Skin Surface – 2 Hourly (22.10.2010 – 3.30 PM)

23.10.2010 (8.30 pm) DIALYSIS 5 – Performed 11 am 23.10.2010 (6 hours) TRANSFUSION –

After repeated administration of PHOSPHORUS 0/2 – 2 hourly, now the hemorrhages from IV sites, oral ulcers and nose were almost under control.

Gauze changing frequency at hemorrhage sites almost reached to 6 hours or 3 times in last 24 hours.

Chief Complaints/Signs and Observations:

Hemorrhages from IV sites, Nose and Oral Aphthous ulcers hemorrhages almost under control.

HEMATURIA

URINE OUTPUT 140 ml/24 hours (ANURIA)

PHYSICAL EXAMINATION

Pulse : 76/m

B.P : 110/68 mmHg

Temp. : 100 degrees F

R/R : 18/m

CVS Exam : S1 S2 Normal, No added sounds.

Lower Extremities pitting oedema+++.

P/A Tenderness.

Chest B/L crepts +++

LAB INVESTIGATIONS

Blood Urea (after dialyisis) : 96mg/dl

S.Creatinine (after dialysis) : 4.9 mg/dl

Platelet Count : 73,000/cmm (1 SDP Transfusion)

Platelet Count raised from 46,000 to 73,000

Now Hemorrhages were almost under control but Platelet Count was a serious matter facing us, so I re-evaluated the case and finally decided to change the prescription this time.

PRESCRIPTION:

Crot. horridus 30c in Liquid Dilution ON SKIN – 2 Hourly (23.10.2010 – 9.30 PM)

24.10.2010 (9.00 pm)

TRANSFUSION – NO SDP in last 24 hours

After repeated administration of Crot. horridus 30c Liquid dilution – 2 hourly on SKIN and without any Transfusion of SDPs the Platelet count was higher than previous day’s report.

Patient was transfused packed cells today as hemoglobin count was 8.2 previous day.

Chief Complaints/Signs and Observations:

Anuria + Hematuria

PHYSICAL EXAMINATION

Pulse : 76/m

B.P : 90/60 mmHg (Dropped down, given some Allopathic Inj. to stabilize)

Temp. : 101 degrees F

R/R : 20/m

CVS Exam : S1 S2 Normal, No added sounds.

Lower Extremities pitting oedema+++.

P/A Tenderness.

Chest B/L crepts +++

LAB INVESTIGATIONS

Platelet Count 80,000/cmm (No SDP transfusion)

Platelet Count raised from 73,000 to 80,000 without any transfusion

PRESCRIPTION:

Crot. horridus 30c in Liquid Dilution ON SKIN – 4 Hourly (24.10.2010 – 9.30 PM)

25.10.2010 to 27.10.2010

Chief Complaints/Signs and Observations:

Anuria + Hematuria

LAB INVESTIGATIONS

Platelet Count 27.10.2010 — 1,10,000/cmm (No SDP transfusion)

Platelet Count raised from 80,000 to 1,10,000 without any transfusion in 3 days.

PRESCRIPTION:

Crot. horridus 30c in Liquid Dilution ON SKIN – 4-6 Hourly (25/26/27.10.2010)

28.10.2010 (9.30 PM)

DIALYSIS 10 – Performed (4 hours)

TRANSFUSION – NO SDP

Chief Complaints/Signs and Observations:

Anuria + Hematuria

LAB INVESTIGATIONS

Platelet Count 28.10.2010 — 1,27,000/cmm (No SDP transfusion)

Platelet Count raised from 1,10,000 to 1,27,000 without any transfusion.

PRESCRIPTION:

Crot. horridus 30c in Liquid Dilution ON SKIN – 6 Hourly (28.10.2010)

29.10.2010 to 2.11.2010

Dialysis 11-15 performed (4-6 hours)

Transfusion  – No SDP

Ventilator Mode – SIMV i.e., Synchronous Intermittent Mandatory Ventilation (Non-invasive, facial mask)

Chief Complaints/Signs and Observations:

Anuria + Hematuria

Mild ECG Changes but no significant.

Pleural Effusion

LAB INVESTIGATIONS

Platelet Count 1.11.2010 — 1,68,000/cmm (No SDP transfusion)

2.11.2010 — 1,72,000/cmm (no SDP transfusion)

Platelet Count raised from 1,27,000 to 1,72,000 without any transfusion in 5 days.

As Platelet Count was Stable now and his life was out of danger, we considered going ahead with a prescription that could intervene with Ventilator Support and pleural effusion so that ventilator could be weaned off.

PRESCRIPTION:

Antimonium tartaricum 0/1 ON SKIN – 2 Hourly (29.10.2010 3.30 PM)

3.11.2010 to 5.11.2010

Dialysis 19-21 – Performed (4-6 hours)

Ventilator Mode – SIMV i.e., Synchronous Intermittent Mandatory Ventilation (Non-invasive, facial mask)

Chief Complaints/Signs and Observations:

Anuria + Hematuria

Pleural Effusion

LAB INVESTIGATIONS

Renal Function Test 4.11.2010 — B. Urea: 108 mg/dl

S. Creat: 2.2 mg/dl

As patient was on Antimonium tart 0/1 and X-Ray changes were quite significant and showed a good response to our medicine, we continued with Antimonium tartaricum 0/1 and then raised to Antimonium tart 0/2 and 0/3 for next days.

PRESCRIPTION:

Antimonium tartaricum 0/2 ON SKIN – 3 Hourly (3/4.11.2010 8.30 PM)

Antimonium tartaricum 0/3 ON SKIN – 4 Hourly (5.11.2010 3.30 PM)

6.11.2010 (MORNING 7 AM)

VENTILATOR WEANED OFF ON 6.11.2010 (5.30 pm) and patient was advised to take some oral liquid diet by next morning.

7.11.2010

Dialysis 22 – Performed (6 hours)

Chief Complaints/Signs and Observations:

Anuria + Hematuria

Cough with Expectoration

Thirst for Cold Drinks

Restlessness

Pain in Lower Abdomen

LAB INVESTIGATIONS

Renal Function Test 7.11.2010 — B. Urea: 82 mg/dl

S. Creat: 1.6 mg/dl

Now we had the patient in a completely stable state and our concern was to track his kidney failure and we needed proper medicine for his renal inactivity.

So finally after an evaluation of 2 hours with reference to numerous texts, we came to selection of Serum anguillae 6x as the final resort.

Prescription Serum anguillae 6x Liquid Dilution Orally – 3 hourly (7.11.2010- 11.30 PM)

Patient Transferred To Nephrology Ward

8.11.2010 to 23.11.2010

Dialysis 22-31 – Performed (4-6 hours)

No dialysis after 16.11.2010

SERUM ANGUILLAE 6x continued for these 15 days with frequent repetition for first 5 days and then ending up with TDS dosage.

Chief Complaints/Signs and Observations: (between these days)

First 3 days (NO IMPROVEMENT)

Anuria + Hematuria

Cough with Expectoration

Pain in Lower Abdomen

4th – 7th day

No Blood in URINE (NO HEMATURIA)

URINE OUTPUT : 200-350 ml/24 hr

Profuse Perspiration in AC’s

Pain in Loins (Rt>Lt)

7th – 15th day (WORKING KIDNEYS)

No Blood in URINE (NO HEMATURIA)

URINE OUTPUT : 700-1500 ml/24 hr (Increased day by day)

Excessive Appetite

Very Dull Pain in Loins, Mild (Rt=Lt)

Chief Consultant Nephrologist (H.O.D.) reported that the kidneys were now in very healthy working condition and the patient was advised a good diet and to walk for 10-15 mins. daily in hospital lobby.

LAB INVESTIGATIONS

Renal Function Test 24.11.2010 — B. Urea: 32 mg/dl

S. Creat: 0.5 mg/dl


Dear Colleagues,

The above mentioned case has been summarized in short so as to make brief detail of full case sheet (almost one and half months of treatment).

As case was in IPD of other Hospital, we could get only Lab Investigation Reports Data for Evidence Based Presentation of the Case. NO X-Ray Films or Other records could be made available due to ethical policy of the hospital.

About the author

Manpreet Bindra

Manpreet Bindra

Dr. Manpreet S Bindra -BHMS (Ldh) DIHom (London) Fellowship in Cardiology
The American Heart Association Certified Healthcare Provider (ECC - Blue Code)
Ex Fellow - The British Institute of Homeopathy, London (UK). Consultant
Homoeopathic Internist & Cardiologist.
Websites: www.cardiolifecare.in,
www.drbindras.in,
www.onlinehomoeopathictreatment.com

7 Comments

  • Yet another life / vital force/dynamis being brought on track and away from the very jaws of death itself!
    Thanks to Homoeopathy, the helplessness of “modern medicine” , and of course, the confidence and skill of Dr. Bindra!

  • for dengu after having all the lab investigation most of the patient from modern treatment except medicine advised for rest,for pain and infection ,paracetamol with diclofenac advised by allopath which may leads stomach disorder because there os no specific medicines,but in homeo there is excellent medicines to ruleout the symptoms totally

  • For dengu the best medicines,euph per,nuxvomica,rhustox ,chellidonium is the best remedy.And also nat mur is quite good to treat dengu

  • Excellent work. “Success comes to those who dare and act; it seldom goes to the timid”. we must also thank the allopaths for manufacturing cases like these with their suppressive treatments and throwing the patients on the verge of death. Good work DrBindra.

  • DEAR DR,
    THIS IS AN EXCELLENT WORK DONE BY U. MOSTLY THE ALLOPATHIC HOSPITALS NEVER ALLOW ANY HELP FROM OUT SIDERS AND SPECIALLY FROM HOMEOPATH. MOST ALLOPATHIC DRS DO NOT BELIEVE IN HOMEOPATHY PARTICULARLY IN CRITICAL CASES. ONE DR IN ALLOPATHIC PRACTICE WAS TREATED BY ME FOR GALL STONES. HE WAS TOTALLY RELIEVED OF PAIN. I TOLD HIM TO CONTINUE WITH HOMEOPATHIC MEDICINES TILL STONES R DISSOLVED. BUT HE DID NOT AGREE THAT STONES COULD BE DISSOLVED BY HOMEOPATHIC MEDICINES. HE GOT OPERATION OF GALL BLADDER AGAINST MY ADVICE. NOW HE IS SUFFERING FROM PAIN IN HIS SPINE. THERE WAS NO HELP. THANKS
    DR SHEKHAR

  • Dear Dr.
    You have done a marvelous symptom surgery and shown you as Homeo Surgeon. Why had you selected
    the last tool ” SERUM ANGUILLAE”. I follow the case upto ANT_T. Kindly elicit it.
    ganesan.m

  • What a classic way to deal with the patient in icu and supported with ventilator near to death.Get marvellous results at different stages with homoeopathic treatment.

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