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Dr. Andrew Rynne
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Dr. Andrew Rynne

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Is hematemesis a symptom of dengue fever?

Answered by
Dr.
Dr. Geeta Sundar

Internal Medicine Specialist

Practicing since :1975

Answered : 1329 Questions

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Posted on Thu, 17 Nov 2016 in Medicines and Side Effects
Question: hello, tragedy befell on my family on 30th Sep when I lost my dear father suddenly . He was 80 years old, was on medication for slight angina for last 20 years, had dementia too since 2012 but was very stable for last 2 years . His sudden demise is a mystery for me and i am not able to find what led to such an acute problem to him. Pl help me as I am unable to forgive me that I should have been extra cautious on what happened to him. For your help, the sequence of events are:
1. On 28th morning my father had fever...99 degree fahrenheit. I gave him Livo Citrizine and fever came down.
2. On 28/29th night he got up twice for urination but urinated very very low quantity. Though he used to take Neurobion very night and so colour of urine in night used to be pale, now in the hindsight I recall that both times the colour of urine that night was slight orangish.
3. On 29th morning, when he was brushing, he vomited. The colour of vomit was very dark green or brownish green. Somehow I did not register the importance of colour of vomit at that time.
5.on 29th during the day his urine output was very low and on 2-3 occasions he did not urinate.
4. Everynight I used to measure my father's BP and pulse since he was taking BP medicine also..Coversyl 2 mg and also Ecospirin 75 AV. For last about one week his pulse at times was touching 100 or went unto 110 - 115.
5. On 29th evening I took my father to a physician. Since my father was on walker and was unable to climb stairs to the doctor's clinic, the doctor came down to the car and examined him in car only. The doctor said that it appeared to be normal viral and gave antibiotic. Also recommended Urimax D instead of Urimax 0.4 which my father was taking for last 2 years.
6. after dinner on 29th, my father was given Urimax 0.4 by mistake (instead of Urimax D). In the evening I had also given him Urispas for any spasm that might be hindering his urination. He got up thrice on 29/30th night but could not urinate. When he did not urinate on the first occasion on that night at about 2 am, I gave him Urimax D thinking that it should help him in easing the urination.
7. 3oth morning, when my father sat on the toilet he did urinate to much our relief. Dut during the day did not urinate. So I gave him Urispas again after the breakfast. and at about 2 pm again when he was unable to urinate, he was again given Uriamx D.
8. in the afternoon his anxiety was very high. I checked BP..it was 155/95 and pulse 136. So I have him Clonazopam 0.25. After an hour asked him if he would like to have lunch. My father got up from bed and had light vegetarian lunch (We are strict vegetarians...not even eggs)
9. After lunch. I accompanied him to bed so that he can lie down and I can go to a doctor for putting him on catheter as even after lunch, he did not urinate.
10. But destiny had this tragedy in store for me.... my father drank some cold water sitting on bed and was wiping his mouth when balck watery discharge came out from his nose...He wiped it himself...I too wondered and exclaimed "Papa what was that". Immediately the discharge came again from nose and while my father was wanting to wipe his mouth, suddenly the black discharge started gushing out of his mouth and within seconds my Darling Father collapsed in my arms. Within 7-8 minutes a doctor friend was there and she pronounced that nothing was there..... And when she saw the vomit, she told that it was all blood. THEN ONLY I could recall that on 29th morning too my father had vomited blood only. I know that it was the biggest blunder of my life to not to take that colour into cognisance.
But Sir, kindly tell me what exactly happened to my father. He never had any kind of GI or rectum bleeding problem...was a pure vegetarian and an absolute teetotaller. So what went so wrong and so severe!!! In the hindsight I also recall that for about one week he was facing some suffocation also especially while eating his meals.
Was it Dengue??? i.e. Dengue Hemorrhagic Fever?????
Was dementia a factor??
OR something else??? WHAT exactly led to this loss in my life?
Kind regards
doctor
Answered by Dr. Geeta Sundar 3 hours later
Brief Answer:
Hi XXXX, welcome to HCM, that was a heart rending story.

Detailed Answer:
Hi XXXX, welcome to HCM, that was a heart rending story. I will not go into what went wrong and what could have been done. I think there could have been many reasons---
Most probable, dengue leading to low platelets and bleeding.
It could have been primarily gastric bleeding--less probable.
It could have been a cause from the liver--orangish urine, followed by bleeding from stomach.
It could be kidney failure ---less urine being passed followed by bleeding from stomach.

Let me try to comfort you and remove some of your guilt. Sometimes although we do our best, things go wrong. And the love you showed your father will compensate everything else. I am sure he is still smiling down at you. All the best, and regards

Above answer was peer-reviewed by : Dr. Raju A.T
doctor
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Follow up: Dr. Geeta Sundar 16 hours later
Thanks Dr Sunder for the reply. Your observations prompt me to request you to please clarify these issues also:

1. Dengue is said to have many prominent symptoms...high fever, body ache, rashes etc. Could my father be down with Dengue and not have these symptoms?

2. Whether Dengue haemorrhagic fever (DHF) take someone in grip instantly and result in internal bleeding immediately without any outward and prolonged symptoms? My father was doing all activities in a normal way...no complaints, no fatigue etc

3. Whether one vomits blood in DHF? The general physician who saw my father on 29th sep, told afterwards that no blood vomiting takes place in dengue.

3A. Whether eating or drinking water aggravate some internal bleeding?

4. If it was a liver problem, he should have had some some symptoms... what should have been those features.

5. Why would kidney failure happen? Does It happen immediately? Or it shows some symptoms over along period of time? what are those symptoms?

6. WHY DID HAEMORRHAGE TAKE PLACE?

7.Why the blood vomit was black in colour and not red?

8. Why the bleeding started from nose?

9. Can overdose of Urimax cause death? I gave it thrice during about 16 hrs.

10. What does bloating of tummy signify? My father's tummy was bloated while he sat in toilet on 30th morning.

Look forward to your reply.

Warm regards, XXXXXXX XXXXXXX XXXXXXX

doctor
Answered by Dr. Geeta Sundar 6 hours later
Brief Answer:
Hi XXXX, Yes, Dengue can present with any or all of these symptoms.

Detailed Answer:
Hi XXXX, I'm answering them sequentially,

Yes, Dengue can present with any or all of these symptoms.

No, it takes time except in a person whose immunity is low. In elderly it can happen.

You can have bleeding from any part of the body if the kidneys or liver gets affected due to dengue.

No

He did have orangish urine and loss of appetite

Kidney failure can happen due to any severe infection due to a condition called DIC--diffuse intravascular coagulation-- it is normally late and takes time but can be rapid in immuno compromised or elderly.

Haemorrhage could be due to DIC, or something called hepato renal syndrome where liver gets affected first leading to kidney failure.

When blood remains in stomach for a length of time (or there is slow bleeding), it turns black.
The blood was from the stomach, it collected and came out through the nose--the gastro intestinal and upper respiratory parts are connected.

It is a remote possibility

Bloating was due to gas/bleeding/fluid accumulation.

Hope this helps. Regards
Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Geeta Sundar 45 hours later
Hello Dr Sunder. Thanks a lot for your point-wise reply. But some more issues are quite worrisome for me….kindly help me understand these…

1.     If so much was going inside my father, how he was able to behave so normal… getting up, moving, walking, reading newspaper, eating etc. Since I used to sleep besides him and after his getting up used to help him get ready before I proceeded for office, I did not observe any such unusual thing on 30th morning. Afterwards my sister was along with him and she also did not observe any such unusual thing.

2.     When my dear father collapsed the blood that gushed out of his mouth was black. If it was due to some hemorrhage inside which ultimately resulted in shock death, the hemorrhage or the burst MUST MUST have been immediate/ instant/ at that point of time. It means that the blood which should have gushed out of his mouth should have been RED in colour. Then why the blood that gushed out of his mouth was black in colour??? As you also explained that “ The blood was from the stomach and that when blood remains in stomach for a length of time (or there is slow bleeding), it turns black.”

3.     Is it possible that in DHF bleeding begins straightway from liver or kidney without any bleeding from nose or gums etc?

4.     The doctor who examined him on 29th evening gave him antibiotic Floxi 500 (Livofloxacin 500). My father took one dose of this medicine on 29th evening. Could that aggravate bleeding in any way?

5.     In his last moments when blood gushed out of his mouth, my father also passed urine. So is it possible that despite kidney failure he could have passed urine like this in his last moments.

6.     We are from XXXXXXX Should the doctor (an MBBS, MD from KGMC, XXXXXXX and an established medical practitioner) who saw my father not have asked me to get the dengue and other tests done??

7.     And, afterwards this doctor told me that natural deaths happen like this. When so much went inside his body, WAS MY FATHER’s DEATH NATURAL IN ANY ANY WAY?????????? Even in today’s age of medical advancement, he had to leave us so unattended medically.

What more should I ask you! Thanking you a lot Dr Sunder in anticipation of your reply.
Sincere regards
doctor
Answered by Dr. Geeta Sundar 3 hours later
Brief Answer:
Hi XXXX, the process was going on slowly in his body

Detailed Answer:
Hi XXXX,

The process was going on slowly in his body that is why the blood was black. It was not sudden, so he was able to partially adjust to his routine. All the signs were there like I explained earlier. It is not appropriate for me to comment about other doctors, maybe he attributed any weakness to your father's age. And with fevers there is no end to the tests that can be advised.

So maybe he wanted to wait and watch.

Levofloxacin normally does not cause this but there is a condition called idiosyncracy where it can happen. Involuntary passage of urine in last moments is normal because body control is lost.

Bleeding in DHF can occur from any part of body--hope things are a bit clearer in your mind.

Let me end by saying that analyzing things in retrospect is easy, but you may have missed out on a few things involuntarily. So while it is good to analyse, it is also good to accept.

Regards.
Above answer was peer-reviewed by : Dr. Arnab Banerjee
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