Interesting case Wednesday, March 27, 2013

Interesting caseWednesday, March 27, 2013Helen, Yani, Sri, Mutia, Bambang, Luna, Dio, Adin, RizaNAW, 10 years, male, Ngelempungsari-Sleman

Referred by a pediatric consultant with the fourth day of fever, a positive Rumple Leede test, decreasing platelet counts, and increasing hematocrit levelsData List Sudden onset of high fever since 3 days before admission, not relieved with the administration of ParacetamolHeadache, myalgia, arthralgia, nausea, no spontaneous hemorrhageTwo of his neighbors are now being hospitalized because of dengue virus infectionData List Fever (39.2oC), right pleural effusion, no signs of shock on physical examinationLaboratory findings:Hematocrit levels: 39.5% (day 2) 42.4% (day 4) 40.0% (at ER)Platelet counts: 295000/mm3 (day 2) 182000/mm3 (day 4) 134000/mm3 (at ER)

Grade I dengue hemorrhagic fever Laboratory FindingsResultsNormal rangeWhite blood cells (/mm3)32004800-10800Neutrophils (%)64.350-70Eosinophils (%)0.02.0-4.0Basophils (%)0.30.0-1.0Lymphocytes (%)23.825.0-40.0Monocytes (%)11.62.0-8.0Hemoglobin (g/dl)13.9>12Hematocrit (%)40.042.0-52.0Platelets (/mm3)134000150000-450000Working DiagnosisGrade I dengue hemorrhagic fever PlanDiagnosticsAnti-dengue IgM and IgG level measurement

ManagementIntravenous fluid RL 3 ml/kg/hour = 69 ml/hourParacetamol 10-15 mg/kg/x = 240 mg/x (if the patient gets fever)Conditions this MorningS: fever (-), headache (+), myalgia (+), arthralgia (+), spontaneous hemorrhage (-)O: good general appearance, fully alertVS: HR 83 x/minute; RR 23 x/minute; t 36.8oCSigns of plasma leakage: palpebral edema (+), pleural effusion (+), ascites (-)Signs of shock: warm extremities, strong pulse, CRT < 2 secondsConditions this Morning22.0004.00Hematocrit40%39%Platelets134000/mm3120000/mm3Plasma protein6Conditions this MorningA: grade I dengue hemorrhagic fever

P: same as previous plan