General Data

:
• • • • Name: MJ Age/sex: 7/M Religion: RC Address: De Gloria Extension, Area B, Batasan Hills Quezon City • DOA: September 9, 2012 • Informant: Father and Grandfather • Reliability: 90%

Chief complaint:

VOMITING

approximately 4 tbsp/ep. non-billous. 3 episodes. temporary lysis of fever • No consult .HISTORY OF PRESENT ILLNESS 4 days PTA • (+) Undocumented fever • (+) Epigastric pain 5/10 • (+) vomiting of previously ingested food. non-projectile. non-bloody. • No other associated symptoms noted • Med: Paracetamol 500 mg/tab.

epigastric pain) • (+) Myalgia • (+) Rash (maculopapular rash) • (+) Weakness • Med: Paracetamol. did not provide lysis of fever • No consult . vomiting.HISTORY OF PRESENT ILLNESS 3 days PTA • Persistence of symptoms (fever.

(-) nasal discharge • Persistence of symptoms • Went to a “manghihilot” • Assessed to have “pilay” .HISTORY OF PRESENT ILLNESS 2 days PTA • (-) melena. (-) epistaxis. (-) hematochezia.

epigastric pain) • (+) cold.HISTORY OF PRESENT ILLNESS Few hours PTA • Afebrile • Persistence of other symptoms (vomiting. clammy extremities • Consult: Pedia ER-EAMC • Platelet: 60 ADMISSION .

no sore throat no hempotysis No chest pain. no eye pain No deafness. no headache No loss of consciousness No blurring of vision. no aural discharge. no anxiety . no tinnitus No dental caries. no eye itchiness. no constipation No polyuria. no dysuria No behavioral changes. polydipsia.REVIEW OF SYSTEMS • • • • • • • • • • • No weight loss. no polyphagia No urinary frequency. (+) loss of appetite. no urgency. no depression. no PND. no palpitations No diarrhea. no orthopnea.

PAST MEDICAL HISTORY • No asthma. PTB • No previous surgery • No previous hospitalization . allergy.

IMMUNIZATION HISTORY • Complete vaccination EPI till 9 months at local health center .

asthma.treated for 6 months • (-) cardiovascular diseases .FAMILY HISTORY • (-) HTN. allergy • TB –father. DM.

Family Profile: Name Age Educational Attainment Employment Health Status AJ 33 HS grad Housekeeper Healthy MJ CJ C 26 5 4 HS grad Housewife Healthy Healthy Healthy .

School • Has 2 siblings • Lives with 2 parents in a 1 story house • No noted dengue epidemic in their community .Personal. Social and Environmental history: • Currently grade 1 student at Rodriguez Rizal Elem.

2-3 mm ERTL • Ears: No aural discharge. turbinates not congested • Mouth: moist buccal mucosa. no ulcers. no nasal discharge. hyposthenic. (+) maculopapular rash over the upper extremities • Eyes: Pink palpebral conjunctiva. anicteric sclera. isocoric pupils. no jaundice. no deformities. no tragal tenderness • Nose: midline nasal septum. no gum bleeding . irritable. weak looking • Vital signs: – BP: Palpatory 60 (p5 85/52) – CR: 116 bpm – RR 23 cpm – Temp 36.PHYSICAL EXAMINATION • Awake.6◦C • Weight: 18Kg • Cold clammy skin.

PHYSICAL EXAMIANTION • Supple neck. non-distended. no murmurs • Flat abdomen. no thrills. no thyroid enlargement. AB 4th LICS MCL. no masses • (-) CVA tenderness • DRE: not done • Weak pulses. (+) epigastric tenderness. S1>S2 at the apex. clear and equal breath sounds • Adynamic precordium. no lifts. normoactive bowel sounds. cold extremities . S2>S1 at the base. no palpable cervical lymph nodes • Symmetrical chest expansion. no retractions. no heaves.

Salient Features: Subjectives: • • • • • • • • 7/M Batasan Hills. Quezon City (+) Vomiting (+) Undocumented Fever (+) Myalgia (+) Epigastric pain (+) rash (-) epistaxis. weak looking Vital signs: – BP: Palpatory 60 (p5 85/52) – CR: 116 bpm – RR 23 cpm – Temp 36. (-) gum bleeding (+) maculopapular rash over the upper extremities and lower extremities (+) epigastric tenderness Weak pulses.6◦C Cold clammy skin. Melena • Unremarkable Past medical histroy Objectives: • • Awake. hyposthenic. cold extremities Thrombocytopenia: Platelet: 60 • • • • • . gum bleeding. irritable.

Approach to Diagnosis • Symptom. sign or laboratory finding pointing to a group of diseases • Fever and Maculopapular rash .

mouth. clearing as it spreads 9-12months Discrete lesions that become confluent as rash spreads from hairline downward. pustules then forming and crusting. lesions may involve scalp. begins on trunk and spreads centrifugally to extremities and face . onset of maculopapular rash.Maculopapular Rash + Fever Patient Measles Roseola Varicella Dengue Age Maculopapular rash lower extremities No age predilection Spreads from hairline downward. sparing palms and soles 1-7 years Macules evolving into papules. intensely pruritic diffuse flushing. on an erythematous base. midway through illness. then vesicles.

Maculopapular Rash + Fever Patient Fever Myalgia Epigastric Pain Signs of Hemodyn amic instability Vomiting Measles + + Roseola + + Varicella + + + Dengue + + + + - - - + .

lasting for 2-7 days. cold extremities Thrombocytopenia: Platelet: 60 Dengue Fever Acute febrile illness Headache Retro-orbital pain Arthralgia Rash Hemorhagic manifestations Leukopenia Supportive serology Confirmed: A case confirmed by laboratory criteria Dengue Hemorrhagic Fever •Fever. or history of fever. RR 23 cpm . Temp 36. occasionally biphasic •Hemorrhagic tendencies evidenced by at least one of the following: 1.6◦C Cold clammy skin (+) maculopapular rash over the upper extremities and lower extremities Weak pulses.000 cells/mm3 orless) •Evidence of plasma leakage due toincreased vascular permeability. A drop in the hematocrit following volume replacement treatment equal to or greater than 20% of baseline 3. Hematemesis or melena •Thrombocytopenia ( 100. and populationb. manifested by at least one of the following: 1. CR: 116 bpm . 3. GIT. injection sites or other locations 5. sex. ascites and hypoproteinemia . Purpura 4. ecchymosis. (+) tourniquet test Petechiae 2. Bleeding from the mucosa. gum bleeding. A rise in the hematocrit equal to or greater than 20% above average for age. Signs of plasma leakage such as pleural effusion. Melena Unremarkable Past medical history VS: BP: Palpatory 60 (p5 85/52).DENGUE Patient (+) Vomiting (+) Undocumented Fever (+) Myalgia (+) Epigastric pain (+) rash (-) epistaxis. 2.

Dengue hemorrhagic fever DHF I (+) Vomiting (+) Undocumented Fever (+) Myalgia (+) Epigastric pain (+) rash BP: Palpatory 60 (p5 85/52). cold extremities Fever. abdominal pain) + Torniquet test DHF !! Grade I + spontaneous bleeding DHF III DHF !V Grade II + severe Grade II I+ bleeding + Irreversible shock circulatory failure + massive bleeding . CR: 116 bpm .6◦C Cold clammy skin maculopapular rash Weak pulses. Temp 36. Non specific constitutional symptoms (vomiting anorexia.

ASSESSMENT • Dengue Hemorrhagic fever III .

aPTT. blood typing. APC. PT. Na.PLAN • PLR (line 1) and PNSS (line 2) • CBC. K. Cl • For admission .

57 0.3 188 0.55 0.0 124 0.1 112 0.06 60 9/11/12 6.CBC w/ APC 9/9/12 WBC Hgb Hct Neutrophils Lymphocytes Monocytes Platelet 4.24 0.04 25 9/12/12 5.39 0.31 0.63 0.320 0.73 0.361 0.03 140 .