You are on page 1of 19

Mortality Report

PINK SERVICE

MARCH 2019
TUNGOL, EDRIAN
General Information
TUNGOL, EDRIAN
6MOS/M
Filipino
Date of Admission: 03/16/2019
Length of Hospital stay: 11 HOURS
Admitting Diagnosis

ACUTE GASTROENTERITIS WITH


SEVERE DEHYDRATION
FINAL DIAGNOSIS
METABOLIC ENCEPHALOPATHY
SECONDARY TO MULTIPLE ELECTROLYTE
IMBALANCE (HYPERNATREMMIA,
HYPOKALEMIA) SECONDARY TO ACUTE
GASTROENTERITIS WITH SEVERE
DEHYDRATION;
STATUS POST INTUBATION
Chief Complaint
LOOSE STOOLS
History of Present Illness
Patient was apparently well until

2days PTA, (+) loose stools x 4 episodes. No vomiting, febrile


episodes, cugh and colds. Patient was given Paracetamol. No consult
done.
1 day PTA, (+) loose stools x 4 episodes, weak looking, consult at
_____ admitted as a case of Acute Gastroenteritis.

Few hours PTA, still with loose stools x 3 episodes, now


accompanied by fast breathing hence transferred in our institution.
Past Medical History
Immunization at par with age at Health Center
No previous hospitalization
COURSE AT THE ER
March 16, 2019
4:20 PM
ER
S: () loose stools O A P
() vomiting HR: 128 • NPO
() febrile episode RR: 49 • Diagnostics: CBCPC,
T: 39 Na, K, Cl, UA, FA,
Wt: 6.7 kg ABG, BUN Crea
HGT: 148 • CXR-APL
Acute Gastroenteritis • IVF: PLRS (Severe
Drowsy with Severe Dehydration)
No pallor, No cyanosis Dehydration • Ceftriaxone
Sunken eyeballs 50mkday OD
Dry lips • Paracetamol
SCE, no retractions, 10mkdose q4 prn
Tachypneic, CBS for temp >37.8
AP, Tachycardic, No • Hook to FM @10
murmur lpm
Soft abdomen, Non
distended
Full pulses
TEST 3/16 3/16 3/16
PH 7.278 NA 154.50 HEMOGLOBIN 105
PO2 207.90 HEMATOCRIT 0.33
K 2.81 WBC 14.1
PCO2 11.40
cHCO3 5.2 Cl 125.80 PLATELET 291
BE -18.90 NEUTROPHILS 59.3
SO2 99.40 LYMPHOCYTES 34.7
MONOCYTES 5.9
EOSINOPHILS 0
COURSE AT THE ER
March 16, 2019
5:20 PM
ER
S: () loose stools O A P
() vomiting HR: 146 • “E” intubation done
() febrile episode RR: 58 • Diazepam
(+) upward rolling of T: 39 0.2mkdose given
eyeballs x 7 minutes • Phenytoin
Drowsy Acute Symptomatic LD:15mkdose /SIVP
No pallor, No cyanosis seizure secondary to then MD:5mkday
Sunken eyeballs Multiple electrolyte q12
Dry lips imbalance secondary • Hook to
SCE, no retractions, to Acute Ambubagging
Tachypneic, CBS Gastroenteritis with • PNSS 20cc/kg IV
AP, Tachycardic, No Severe Dehydration Bolus given
murmur • Insert second line
Soft abdomen, Non • IVF 1: PLRS 73cc/hr
distended • IVF 2: PNSS 500cc +
Full pulses 20meqs KCl x
20cc/hr to run for
24hrs
COURSE AT THE ER
March 16, 2019
5:20 PM
ER
S: () loose stools O A P
() vomiting HR: 146 • HGT q8 while on
() febrile episode RR: 58 NPO
(+) upward rolling of T: 39 • Ranitidine 1mkdose
eyeballs x 7 minutes q8
Drowsy • Start Dobutamiine
No pallor, No cyanosis Acute Symptomatic drip (5)
Sunken eyeballs seizure secondary to • Insert IFC, secure
Dry lips Multiple electrolyte consent
SCE, no retractions, imbalance secondary • May transfer
Tachypneic, CBS to Acute patient to ward
AP, Tachycardic, No Gastroenteritis with
murmur Severe Dehydration;
Soft abdomen, Non Status post intubation
distended
Full pulses
COURSE AT THE ER
March 16, 2019
5:20 PM
ER
S: () loose stools O A P
() vomiting HR: 146 • HGT q8 while on
() febrile episode RR: 58 NPO
(+) upward rolling of T: 39 • Ranitidine 1mkdose
eyeballs x 7 minutes q8
Drowsy • Start Dobutamiine
No pallor, No cyanosis drip (5)
Sunken eyeballs Acute Symptomatic • Insert IFC, secure
Dry lips seizure secondary to consent
SCE, no retractions, Multiple electrolyte • For repeat Na, K, Cl,
Tachypneic, CBS imbalance secondary Ica, Mg, ABG
AP, Tachycardic, No to Acute • May transfer
murmur Gastroenteritis with patient to ward
Soft abdomen, Non Severe Dehydration; (Ideally at ICU but
distended Status post intubation no available bed)
Full pulses
CHEST XRAY 3/16/18
COURSE AT THE WARD
March 16, 2019
8:300 PM

S: () loose stools O A P
() vomiting HR: 136 • Continue ongoing
() febrile episode RR: 46 hydration
(-) seizzure episodes T: • For repeat
electrolytes post
Asleep, comfortable Acute Symptomatic correction
Pinkish seizure secondary to • For transfer to ICU
Good air entry Multiple electrolyte once available
No pallor, No cyanosis imbalance secondary • VS q1
Slightly sunken to Acute • Close watch
eyeballs Gastroenteritis with • Refer
Dry lips Severe Dehydration;
SCE, no retractions, Status post intubation
Tachypneic, CBS
AP, Tachycardic, No
murmur
Soft abdomen, Non
distended
Full pulses
COURSE AT THE WARD
March 17, 2019
12:45 AM

S: () loose stools O A P
() vomiting HR: 180s • For repeat serum
() febrile episode RR: assisted (+) spont electrolytes post
(-) seizure episodes T: 38.8 correction
• Reintubation done
(+) cyanosis Acute Symptomatic • Hook to cont.
No pallor, No cyanosis seizure secondary to ambubagging
Slightly sunken Multiple electrolyte • Hook to CMV once
eyeballs imbalance secondary available
Dry lips to Acute • Start Amikacin
SCE, no retractions, Gastroenteritis with 15mkday OD
Tachypneic, CBS Severe Dehydration; • Revise IVF as
AP, Tachycardic, No Status post intubation follows:
murmur • IVF1: D50.45 NaCl
Soft abdomen, Non to run at 61-62
distended cc/hr
Full pulses
COURSE AT THE WARD
March 17, 2019
12:45 AM

S: () loose stools O A P
() vomiting HR: 180s • IVF 2: Cpntinue
() febrile episode RR: assisted (+) spont present IVF
(-) seizzure episodes T: 38.8 • Monitor hydration
status
(+) cyanosis Acute Symptomatic • Vs q1
No pallor, No cyanosis seizure secondary to • Close watch
Slightly sunken Multiple electrolyte • Refer
eyeballs imbalance secondary
Dry lips to Acute
SCE, no retractions, Gastroenteritis with
Tachypneic, CBS Severe Dehydration;
AP, Tachycardic, No Status post intubation
murmur
Soft abdomen, Non
distended
Full pulses
COURSE AT THE WARD
March 17, 2019
2:55 AM

S: () loose stools O A P
() vomiting HR: 20s • CPR done
() febrile episode RR: Assisted • PNSS 20cc/kg IV
(-) seizure episodes T: Metabolic bolus given
Encephalopathy • Epinephrine
Gasping secondary to Multiple 0.2mkdose x 6
Cyanotic electrolyte imbalance doses given
Good air entry secondary to Acute • Prnunced dead at
Equal chest rise Gastroenteritis with 3:20 am
No pulses Severe Dehydration; • Please do post
Status post intubation mortem care
+Insufficient bagging • Advised
by the grandmother.
Both parents were
seen asleep
TEST 3/17 3/17
PH 7.488 NA 158.20
PO2 211.30
K 2.45
PCO2 9.90
cHCO3 7.30 Cl 121.90
BE -13.00
Ica 1.27
SO2 99.60
Mg 1.10