Case presentation

In this detailed case presentation, Dr. Khounelaphet Touphaythoune from Savannakhet Provincial Hospital discusses the history, physical examination, problem list, differential diagnosis, investigation, and management of a 6-year-old female presenting with high-grade fever, vomiting, poor intake, and abdominal pain. The diagnosis of Dengue fever with warning signs is supported by laboratory findings and clinical assessment.

• Case presentation
• Dengue fever
• Diagnosis
• 6-year-old female
• Management

medidoc Follow

Uploaded on Feb 14, 2025 | 0 Views

Download Presentation

Please find below an Image/Link to download the presentation.

The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author.If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.

You are allowed to download the files provided on this website for personal or commercial use, subject to the condition that they are used lawfully. All files are the property of their respective owners.

The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author.

Presentation Transcript

1. Case presentation By Dr khounelaphet Touphaythoune Savannakhet provincial hospiatl

2. History 6 , 16/2/19 12h8

3. History 4 + +

4. Present history 4 , , 16/2/19 2 (100 ), ( ), , , , 9 , 12

5. Past history 2/2 ,

6. Physical examination V/S: BP 80/40 mmHg strong, RR 24/min, HR 88/min strong, T 36.5 C W: 22kg GA: Alert, vomiting 2 times, not pale, warm, CRT< 2sec, no dry lip, no dyspnea, TT(-)ve HEENT: no microcephaly, no gum bleeding, pharynx no redness, not injected, no lymphadenopathy Skin: no petechiae, no ecchymosis

7. Physical examination RS: no retraction, normal breath sound, lung clear CVS: normal S1S2, no murmur, no tachycardia Abdomen: soft, no distention, abdominal pain on epigastrium, liver 2cm , spleen not palpable CNS: no irritable, BBK, clonus negative, no stiff neck, Kernig's sign negative, good consciousness

8. Problem list Female 6 years old High grade fever 4days History of treatment with IV fluid 100ml Vomiting, poor intake Abdominal pain Liver 2cm

9. Differential diagnosis Dengue fever with warning sign Appendicitis

10. Diagnosis Dengue fever with warning sign

11. Investigation CBC 16/2/19 at 12h30 WBC GRA Hb HCT MCV MCH RDW PLT Serology 4,220/mm3 71% 13,3g/dl 41,8% 71 22,5 14,8% 102,000/mm3 Test dengue (-) ve NS1 (+) ve IgG (-) ve IgM (-) ve Blood group ( O+ )

12. Management 16/2/19(D4) Time 12h38 Vital sign BP 80/40 mmHg T 36.5 C RR 24 bpm/min HR 88 bpm/min CRT <2sec, warm Sign & Symptom good consciousness Vomiting 2times Abdominal pain on epigastrium Liver 2cm Urine 60ml/2hr No vomiting Abdominal pain same Management RL 5ml/kg/hr x 2hr v/s q 2hr Lab WBC 4,220/mm3 HCT 41.8% PLT 102,000/mm3 NS1 positive IgG (-)ve, IgM (-)ve RL 3ml/kg/hr 14h30 6h00 BP 80/50 mmHg T 37 C RR 24 bpm/min HR 82 bpm/min CRT <2sec, warm Total Fluid 18hr IV 1600ml, Oral 190ml Urine 1070ml (2.4ml/ml/hr)

13. Management 17/2/19(D5) Time 7h30 Vital sign Sign & Symptom Management Lab BP 80/60 weak T 36 C RR 30bpm/min HR 102 bpm/min weak CRT 3sec Abdominal pain all Vomiting Cool On Foley tube Urine 150ml Off RL NSS 10ml/kg/hr v/s q 1hr WBC 2,420/mm3 HCT 46.7% PLT 9,000/mm3 NSS 7ml/kg/hr 8h30 BP 80/50 strong T 37 C RR 25 bpm/min HR 96 bpm/min weak CRT 2sec Abdominal pain Vomiting Warm Urine 100ml WBC 3,700/mm3 HCT 44% PLT 32,000/mm3

14. Management 17/2/19(D5) Time 9h30 Vital sign Sign & Symptom Management Lab BP 80/50 strong T 37 C RR 24 bpm/min HR 94 bpm/min strong CRT 1sec Abdominal pain all No vomiting Warm Water oral 200ml Urine 100ml Off NSS Continue RL 7 ml/kg/hr RL 5ml/kg/hr 10h30 BP 80/50 weak T 37 C RR 24 bpm/min HR 110 bpm/min weak CRT 2sec Abdominal pain No vomiting Warm Urine 0 ml

15. Management 17/2/19(D5) Time 11h30 BP 80/50 weak T 37.5 C RR 30 bpm/min HR 110 bpm/min strong CRT 2sec 12h30 BP 80/70 weak T 37.5 C RR 34 bpm/min HR 120 bpm/min weak CRT 2sec Vital sign Sign & Symptom Management Lab Abdominal pain all No vomiting warm Urine 0ml Off RL NSS 10 ml/kg/hr Pre crossmatch WBC 5,070/mm3 HCT 46.8% PLT 5,000/mm3 Abdominal pain No vomiting Warm Urine 100 ml Off NSS Dextran 10ml/kg/hr WBC 4,310/mm3 HCT 45% PLT 12,000/mm3

16. Management 17/2/19(D5) Time 13h30 BP 96/60 strong T 37.5 C RR 38 bpm/min HR 98 bpm/min strong CRT 1sec 14h30 BP 90/60 strong T 38 C RR 38 bpm/min HR 102 bpm/min weak CRT 1sec Vital sign Sign & Symptom Management Lab Abdominal pain all No vomiting Warm Water oral 20ml Urine 100ml Dextran 7 ml/kg/hr Off dextran RL 5 ml/kg/hr WBC 4,710/mm3 HCT 34.9% PLT 5,000/mm3 Abdominal pain all No vomiting Warm Urine 200 ml

17. Management 17/2/19(D5) Time 15h30 Vital sign Sign & Symptom Management Lab BP 100/70 strong T 37.5 C RR 38 bpm/min HR 90 bpm/min strong CRT 1sec Continue RL 5 ml/kg/hr Abdominal pain all No vomiting Warm Water oral 20ml Urine 150ml 16h30 BP 80/50 weak T 37.8 C RR 38 bpm/min HR 102 bpm/min weak CRT 1sec Continue RL 5 ml/kg/hr WBC 4,580/mm3 HCT 37% PLT 2,000/mm3 Abdominal pain all No vomiting Warm Urine 100 ml

18. Management 17/2/19 (D5) Time 17h30 Vital sign Sign & Symptom Management RL 3 ml/kg/hr Lab BP 100/60 strong T 37 C RR 32 bpm/min HR 98 bpm/min strong CRT 1sec Abdominal pain all No vomiting Warm Urine 100ml BP 90/60 strong T 37 C RR 32 bpm/min HR 100 bpm/min CRT 1sec Continue RL 3 ml/kg/hr x 2hr 18h30 20h30 Abdominal pain all No vomiting Warm Urine 220 ml

19. Management 17-18/2/19(D5-D6) Time Vital sign Sign & Symptom Management Lab BP 80-90/50-60 strong T 36.5 - 37 C RR 32-51 bpm/min HR 98-112 bpm/min strong CRT 1sec No abdominal pain No vomiting Warm Water oral 80ml Urine 20-100m /hr CBC at 21h00 WBC 5,660/mm3 HCT 39.8% PLT 6000/mm3 21h30 6h00 RL 1.5 ml/kg/hr x 10hrs V/S q 3hr CBC at 6h00 WBC 5,000/mm3 HCT 40.7% PLT 6000/mm3 Total Fluid: Input 2116ml ( IV 2064ml , Oral 110ml ) Out put 1860ml = 3.5ml/kg/hr

20. Management 18/2/19 (D6) Time Vital sign Sign & Symptom Management Lab BP 90/60 mmHg strong T 37 C, RR 53 bpm/min HR 72 bpm/min CRT 1sec Good appearance Warm want to have breakfast Off IV Start furosemide 1MKD V/S q 6hr 7h00 BP 100/70 strong T 37 C, RR 45 bpm/min HR 76 bpm/min Furosemide 1MKD q 6hr then off 20/2/19 and discharged Blood Chemistry discharged K 4.3 mmol/L. WBC 7,180/mm3 Na 139 mmol/L. HCT 39.7% Cl 108 mmol/L. PLT 100.000/mm3 BUN 30 mg/dl Cr 0.57 mg/dl Calcium 7.7 mg/dl Glycemia 57.7mg/dl Alb 2.2 g/dl CBC before 8h00

21. Final diagnosis Dengue fever with compensated shock

22. Thank You