mr dengue 25 april 12 00.pptx of indonesia

morning report

1. 25/4/23 Referenced value Hb (g/dL) 13.3 13.0 - 16.0 Hematocrit (%) 39.6 37 – 49 RBC (milion/ul) 4.92 4.5-5.3 Leukocyte (/µL) 3.000 4.500 – 13.500 Thrombocyte (/uL) 93.000 150.000 – 450.000 MCV (fl) 80.5 78.0 - 95.0 MCH (pg) 27.0 26.0 – 32.0 MCHC (g/dl) 33.6 32- 36 Neut % 70.3 33-76 Lymph % 22.4 15 - 55 NS 1 Dengue Positive negative 1 Laboratory Findings at lab dr. Tony Thrombocytopenia Leucopenia NS1 dengue positif

2. Differential Diagnosis Dengue fever without warning sign A90 DD/ 1. Chikungunya J02.9 2. Malaria B17.9 3. Zika Infection A92.5 2

3. Working Diagnosis Dengue without warning sign A90 3

4. Initial Managements 4 Fluid & nutrition IVFD D5 ½ NS 2000ml / day (holiday segar maintenance) Antipyretic IV Paracetamol 500 mg (10 mg/ kgBW / Dose) Planning Diagnostic Complete blood count, peripheral blood smear, IgG IgM Dengue Day 6, PCR- RT Dengue (if available) Planning Monitoring Pulse rate and volume of pulse, temperature, blood pressure, CRT, overload sign, balance diuresis, bleeding manifestation, feeding tolerance state of consciousness, sign of shock, CBC and HCT monitoring every 24 hours Education Educate family about disease, planning monitoring, therapy and prognosis. Consult to supervisor in charge Consult to Tropic Infection Division Plan to hospitalization in tropic infection division ward

5. Problem List History taking Physical examination: 5

6. Problem List Laboratory finding Thrombocytopenia Leucopenia NS1 dengue positive 6

7. Final Diagnosis Dengue without warning sign A90 7

8. Final Managements 8 Fluid & nutrition IVFD D5 ½ NS 2000ml / day (holiday segar maintenance) RDA requirements : Calorie (50-60) x 48 = 2400-2880 kcal/day Protein 0.9 x 48 = 43 g/day Fluid = (50-60) x 43 = 2150 - 2580 ml/day via oral route with: Regular meal 3 x 600 kcal (1800 kcal) UHT Milk 3x 250ml (600kcal) Fulfilled (2400 kcal ~ 100% RDA, 12.5 % PER) Antipyretic IV Paracetamol 500 mg (10 mg/ kgBW / Dose) Planning Diagnostic peripheral blood smear, IgG IgM Dengue Day 6, PCR- RT Dengue (if available) Planning Monitoring Pulse rate and volume of pulse, temperature, blood pressure, CRT, overload sign, balance diuresis, bleeding manifestation, feeding tolerance state of consciousness, sign of shock, CBC and HCT monitoring every 24 hours Education Educate family about disease, planning monitoring, therapy and prognosis. Consult to supervisor in charge Consult to Tropic Infection Division Plan to hospitalization in tropic infection division ward

9. Pediatric Nutrition Care Assessment Normoweight + normal stature + well nourished + dengue without warning sign 2. Determination of calorie needs Recommended Daily Allowance: Calorie (50-60) x 48 = 2400-2880 kcal/day Protein 0.9 x 48 = 43 g/day Fluid = (50-60) x 43 = 2150 - 2580 ml/day 3. Route of feeding : oral route 4. Determining type of food Regular meal 3 x 600 kcal (1800 kcal) UHT Milk 3x 250ml (600kcal) Fulfilled (2400 kcal ~ 100% RDA, 12.5 % PER) 5. Monitoring and evaluation Feeding tolerance 9

10. Consult to Supervisor in charge dr. Choirul Anam, M.Biomed , Sp.A Agree to current management and therapy Educate to maintain oral hydration 10

11. Consult to Tropic-infection Division dr. Astarini Hidayah, Sp.A Agree to current management and therapy 11

12. 12 Wednesday, 26 th April 2023 S Fever (-) nausea (-) vomit (-) headache (-) , pale (-), bleeding manifestation (-) O GCS E4V5M6 BP: 110/70 mmHg Diuresis 2.3 ml/ kgBW /hour Pulse : 89 bpm                         Balance +25 ml/6 hours RR: 20 times/minute Temp: 36.9 o C SpO 2 : 99% room air CRT <2 seconds VAS score 1 with pain reliever Thoracal Exam Inspection : wasted ribs (-) retraction (-) Palpation : symmetrical of vocal fremitus, axilla lymph nodes enlargement (-) Percussion : sonor at both lungs Auscultation : no decreased of breath sounds , rhonchi (-), wheezing (-), stridor (-) Abdominal Exam. I : Distended (-) A: bowel sound (+) 8-12 times/minute P : hepatomegaly (-), splenomegaly (-), tenderness (-) at epigastric region, McBurney (-), psoas sign (-), Rovsing sign (-), ascites (-) P : shifting dullness (-), timpani (+) Warm, CRT < 2 seconds, edema (-), cyanotic (-), pale (-), edema (-) Petechiae (-) convalescent rash (-), Rumple leed test (-) A Dengue without warning sign A90 Follow Up

13. 13 Wednesday, 26 th April 2023 P Planning Diagnostic peripheral blood smear, IgG IgM Dengue Day 6, PCR- RT Dengue (if available) Planning Monitoring Pulse rate and volume of pulse, temperature, blood pressure, CRT, overload sign, balance diuresis, bleeding manifestation, feeding tolerance state of consciousness, sign of shock, CBC and HCT monitoring every 24 hours G No bleeding manifestation Normal vital sign and CRT No fever (body temp 36.5 – 37.5 C) Thrombocyte >50.000 Normal HB (> 15 gr/dl) Diuresis >1 ml/ kgBW /hour No fluid overload I Fluid maintenance 2000ml per day fulfilled with IVFD RL 1250 ml and oral intake 750ml IV Paracetamol 500 mg (10 / kgBW /dose) if fever Follow Up

14. Thank Y ou