Case Dengue Hemorrhagic Fever

5
CC: 1 hr PTA

PI
1 PTA
1 PTA .
PH: No U/D, No drug allergy

PE
BT 39.9 C PR 132 RR 26 BP 100/60 mmHg
HEENT: not pale no jaundice
Heart: normal S1 S2, no murmur
Lungs:clear
Abdomen: soft full bladder mild tender
Ext: no lesion
Neuro sign:Normal concious

LaB
CBC
Hb 10.7 Hct 33 WBC 8000 N 83% L 14%
Plt.180000
UA: sp.gr. 1.010 pH 6.5 WBC 1-2 RBC 0 Sq.Epi 0-1
Blood chem
Na 134 K 3.6 Cl 101 HCO3 20.7

Management
Admit R/O acute pyelonephritis
Cold pack at suprapubic
Paracetamol(500) tab oral for fever q 4-6 hr
5% DN/3 iv drip 40 ml/hr

Admit Day2

PE: Fever 40.5 C PR 124/min pulse full

BP 110/70 mmHg RR 24/min
Abdomen: soft not tender
I/O 1400/2000

Management Day2
Repeat CBC
Hb 10.7 Hct 33% WBC 7400 Plt.166000
N 83% L 16%
Tournique test positive
Serial Hct q 6 hr(34%,34%,35%,37%)
5% DN/3 iv drip 40 ml/hr

Admit Day3
Fever day 3
Pulse full
V/S PR 120/min BT 38.6 C RR26/min BP
90/60mmHg
I/O 2836/2700

Management day3
Repeat CBC today
Hb 11.1 HCT 34% WBC 2600 N 44% L52%
Plt. 126,000
Hct q 6hr
Observe V/S q 4 hr BP< 90/60 mmHg
PP< 20 PR> 120/min
Repeat CBC
5%DNSS iv drip 60ml/hr

Admit Day4
High grade fever
Peripheral pulse full
Hct 34-39
V/S BT 38.6 C RR 26/min PR 110/min
BP 100/60 mmHg
I/O 2916/3100

Management Day4
5%DNSS iv drip 60ml/hr
Serial Hct q 4hr if > 40 pls notify
Record v/s q 4hr if HR>120/min PP<20
BP<90/60 mmHg pls notify
CBC
Hb11.2 Hct 35% WBC 2000 N 56% L 40%
Plt 69000
Repeat CBC

Admit Day5
Peripheral pulse full(96)
Fever
Hct 34-36%
V/S BT 39C PR 120/min BP 100/60 mmHg
RR 27/min
I/O 4200/5100

Management Day5
5% DNSS IV drip 60 ml/hr
Hct q 4 hr if >40 <32
V/S q 4hr if BP<90/60 mmHg PR>120 PP<20
Pls notify
CBC
Hb 10.2 Hct 31% WBC 1700 N 47% L 48%
Plt. 11,000
Repeat CBC E Plt.7000 no clinical bleed => refer

ADMIT

DAY 1

DAY 2

DAY 3

DAY 4

DAY 5

BT

39.9

40.5

38.6

38.6

39

BP

100/60

110/70

90/60

100/60

100/60

PR

132

124

120

110

120

RR

26

24

26

26

27

1400/
2000

2836/
2700

2916/
3100

4200/
5100

34,34
35,37

34,35
36,39

36,35,34 34
35,35,34

V/S

I/O

HCT

33