August 4, 2011 JI Janill Magano JI Shangrila Dimol JI Jasper Pablo

ADMISSIONS

UPDATES

Far Eastern University Dr. Nicanor Reyes Medical Foundation Department of Child Health

502A T. S., 4 y/o, male 21st hospital day,>2mos DOI Working Diagnosis: ALL FAB L1 Subjective Complaints: (-) abdominal pain (-) cough (-) nasal discharge (-) sore throat (-) myalgia/arthralgia (-) malaise

Far Eastern University Dr. Nicanor Reyes Medical Foundation Department of Child Health

O A P

Conscious, coherent, afebrile, not in distress BP = 100/60mmHg CR = 86bpm RR = 25cpm T = 36.9oC P.E. findings are essentially normal ALL FAB L1

Defer urine Specific Gravity Facilitate Vincristine and Doxorubicin May go home if well after chemotherapy

Far Eastern University Dr. Nicanor Reyes Medical Foundation Department of Child Health

503A J.O., 8/12 mos, female 5th hospital day Working Diagnosis: Dengue Hemorrhagic Fever I Subjective Complaints: (-) abdominal pain (-) cough (-) nasal discharge (-) sore throat (-) myalgia/arthralgia (-) malaise

Far Eastern University Dr. Nicanor Reyes Medical Foundation Department of Child Health

O A P

Conscious, coherent, afebrile, not in distress CR = 120bpm RR = 28cpm T = 36.7oC UO = cc/24 hr CRT = <2secs P.E. findings are essentially normal Dengue Hemorrhagic Fever I - resolved

May go home

Far Eastern University Dr. Nicanor Reyes Medical Foundation Department of Child Health

503C K.D., 1 y/o, male 3rd hospital day,8th DOI Working Diagnosis:

Pneumonia prob. Viral Some dehydration corrected Impacted cerumen, AD

Subjective Complaints: (-) productive cough (-) fever (-) vomiting (-) difficulty of breathing

Far Eastern University Dr. Nicanor Reyes Medical Foundation Department of Child Health

O A P

Conscious, coherent, afebrile, not in distress CR = 112bpm RR = 32cpm T = 36.8oC Congested turbinates with post-nasal drip (+) crackles mid to base, bilateral with good air entry Pneumonia probably viral - resolved Some dehydration corrected Impacted cerumen, AD For possible discharge

Far Eastern University Dr. Nicanor Reyes Medical Foundation Department of Child Health

503D V.L., 4 y/o, male 4th hospital day, 8TH DOI Working Diagnosis: Dengue Hemorrhagic Fever I Subjective Complaints: (-) abdominal pain (-) headache (-) bleeding (+) hyperemic pharyngeal wall (+) rash on upper extremities

Far Eastern University Dr. Nicanor Reyes Medical Foundation Department of Child Health

Conscious, coherent, fretful, afebrile, not in distress BP = 100/60mmHg CR = 88bpm RR = 32cpm T = 36.7oC UO = cc/24 hr CRT = <2secs Congested turbinates Gargling on RUQ and epigastric area Abdominal girth: 53cm (from 47cm) Full and equal pulses

Far Eastern University Dr. Nicanor Reyes Medical Foundation Department of Child Health

A P

Dengue Hemorrhagic Fever I

DAT except dark-colored foods Repeat CBC with PC at 6 am IVF D5NSS at a rate of 42cc/hr (3cc/kg)

Far Eastern University Dr. Nicanor Reyes Medical Foundation Department of Child Health

503G T. B., 6 y/o, female 5th hospital day, 10th DOI Working Diagnosis: Dengue Hemorrhagic Fever I Subjective Complaints: (-) abdominal pain (+) cough (-) nasal discharge (-) sore throat (-) myalgia/arthralgia (-) malaise

Far Eastern University Dr. Nicanor Reyes Medical Foundation Department of Child Health

Conscious, coherent, afebrile, not in distress BP = 100/60mmHg CR = 84bpm RR = 23cpm T = 36.8oC UO = cc/24 hr CRT = <2secs Flushed skin Hyperemic pharyngeal wall Decreased breath sound at low mid to base more on the right Tenderness on epigastrium and RUQ Full and equal pulses

Far Eastern University Dr. Nicanor Reyes Medical Foundation Department of Child Health

A P

Dengue Hemorrhagic Fever I

DAT except dark-colored foods Repeat CBC with PC at 6 am IVF D5NSS 1L at a rate of 36 cc/hr (22cc/kg) Paracetamol 250 mg/5 ml temp > 37.8oC Famotidine 7mg q12o TSIV Hydroxyzine 10mg BID for itching Advised high back rest

Far Eastern University Dr. Nicanor Reyes Medical Foundation Department of Child Health

503H T. B., 17 y/o, female 3rd hospital day, 8th DOI Working Diagnosis: Dengue Hemorrhagic Fever II Subjective Complaints: (+) cough (-) abdominal pain (-) bleeding (-) nasal discharge (-) sore throat (-) myalgia/arthralgia (-) malaise

Far Eastern University Dr. Nicanor Reyes Medical Foundation Department of Child Health

Conscious, coherent, afebrile, not in distress BP = 90/60mmHg CR = 72bpm RR = 20cpm T = 37.1oC UO = cc/24 hr CRT = <2secs Palatal petechiae Clear breath sounds Tenderness on epigastric area and RUQ

Far Eastern University Dr. Nicanor Reyes Medical Foundation Department of Child Health

A P

Dengue Hemorrhagic Fever II

DAT except dark-colored foods Repeat CBC with PC at 6 am IVF D5NSS at a rate of 83cc/hr (22cc/kg) Paracetamol 250 mg/5 ml,

Far Eastern University Dr. Nicanor Reyes Medical Foundation Department of Child Health

ISO7 K.A., 9 y/o, male 31st hospital day, 33rd DOI Working Diagnosis: Miliary TB malnutrition sec. Anemia of chronic disease sec. Otomycosis, AU Chronic OM, AU Some dehydration corrected Intracranial abscess vs Tuberculoma Aural polyp, AS Subjective Complaints: (-) cough (-) fever (-) headache (-) abdominal pain

Far Eastern University Dr. Nicanor Reyes Medical Foundation Department of Child Health

Conscious, coherent, afebrile, not in distress BP = 100/60mmHg CR = 86bpm RR = 25cpm T = 36.9oC Adynamic precordium, regular rate, regular rhythm, with skip beats, no palpable thrills, no heaves, no murmurs

Far Eastern University Dr. Nicanor Reyes Medical Foundation Department of Child Health

A P

Dengue Hemorrhagic Fever I

DAT Lumbar puncture deferred Refer to Cardio service Continue medications

DISCHARGE

J.B.
10 years old Male Admitted last July 29, 2011 Discharged August 3, 2011 ADMITTING DIAGNOSIS:
Systemic Viral Infection

FINAL DIAGNOSIS:
Dengue Hemorrhagic Fever Grade II

COURSE IN THE WARD

UPON ADMISSION
Awake, weak looking, not in cardiorespiratory distress with some signs of dehydration BP: 110/70mmHg CR: 99/min RR: 21/min Temp: 38.4oC Whitish iris, OS (-) ROR reflex, OU Congested turbinates Hyperemic pharyngeal wall with postnasal drip Dry lips with moist buccal mucosa

UPON ADMISSION
Diet as tolerated except for dark colored foods Venoclysed with D5 0.3NaCl to run at 133cc/hr for 6hrs (30cc/kg) CBC w/ PC revealed RBC Ct.: 5.04, Hgb: 14.00, Hct: 0.42, WBC Ct.: 2.85, Seg: 0.66, Lymph: 0.25, Mono: 0.07, Eo: 0.02, Plt: 151 Urinalysis was requested Paracetamol, 250mg/5mL, 6mL q4o for temp. > 37.8oC (TD: 11.2mkd) IVF was regulated to 89cc/hr to run for 18hrs and D5IMB to follow at same rate (60cc/kg)

ND 2

HOSPITAL DAY

TH (5

DOI)

Afebrile, conscious, weak-looking, not in cardiopulmonary distress BP: 80/60mmHg CR: 86/min RR: 21/min Temp: 36.9oC Whitish iris, OS (-) ROR reflex, OU Congested turbinates Hyperemic pharyngeal wall with post-nasal drip Dry lips with moist buccal mucosa (+) tenderness at epigastric area and right upper quadrant Liver span of 7.5cm with palpable 2cm liver edge

ND 2

HOSPITAL DAY

TH (5

DOI)

Diet as tolerated except for dark colored foods Repeat CBC w/ PC was done which revealed RBC Ct.: 5.29, Hgb: 14.90, Hct: 0.44, WBC Ct.: 3.30, Seg: 0.50, Lymph: 0.39, Mono: 0.11, Plt: 126 Urinalysis was done which revealed 24/hpf WBC and 1-2/hpf RBC IVF was shifted to D5NSS to run at same rate. IVF was decreased to 66cc/hr (2.5cc/kg)

RD 3

HOSPITAL DAY

TH (6

DOI)

Afebrile, conscious, weak-looking, not in cardiopulmonary distress BP: 90/60mmHg CR: 78/min RR: 21/min Temp: 37.3oC Whitish iris, OS (-) ROR reflex, OU Congested turbinates Hyperemic pharyngeal wall with post-nasal drip Dry lips with moist buccal mucosa (+) tenderness at epigastric area and right upper quadrant Liver span of 7.5cm with palpable 2cm liver edge (+) gum bleeding

RD 3

HOSPITAL DAY

TH (6

DOI)

Diet as tolerated except for dark colored foods Repeat CBC w/ PC was done at 6am which revealed RBC Ct.: 5.08, Hgb: 14.30, Hct: 0.42, WBC Ct.: 3.77, Seg: 0.59, Lymph: 0.32, Mono: 0.09, Plt: 63 Repeat CBC w/ PC was done at 9pm which revealed RBC Ct.: 4.96, Hgb: 13.70, Hct: 0.41, WBC Ct.: 6.51, Seg: 0.54, Lymph: 0.40, Mono: 0.04, Eo: 0.02, Plt: 50 IVF continued

TH 4

HOSPITAL DAY

TH (7

DOI)

Afebrile, conscious, weak-looking, not in cardiopulmonary distress, with good appetite BP: 90/60mmHg CR: 72/min RR: 22/min Temp: 36.5oC Whitish iris, OS (-) ROR reflex, OU Congested turbinates Hyperemic pharyngeal wall with post-nasal drip Moist lips with moist buccal mucosa (+) tenderness at epigastric area and right upper quadrant Liver span of 7.5cm with palpable 2cm liver edge (+) gum bleeding

TH 4

HOSPITAL DAY

TH (7

DOI)

Diet as tolerated except for dark colored foods Repeat CBC w/ PC was done at 6am which revealed RBC Ct.: 4.99, Hgb: 13.90, Hct: 0.41, WBC Ct.: 7.75, Seg: 0.62, Lymph: 0.32, Mono: 0.04, Eo: 0.02, Plt: 52 Started on Hydroxyzine dihydrochloride (Iterax) 2mg/ml, 7ml q12o or PRN for itchiness (TD: 1mkd) IVF site was changed and decreased to 53cc/hr (2cc/kg)

TH 5

HOSPITAL DAY

TH (8

DOI)

Afebrile, conscious, coherent, playful, not in cardiopulmonary distress, with good appetite BP: 90/60mmHg CR: 81/min RR: 20/min Temp: 36.5oC Whitish iris, OS (-) ROR reflex, OU Congested turbinates Hyperemic pharyngeal wall with post-nasal drip Moist lips with moist buccal mucosa (-) tenderness at epigastric area and right upper quadrant Liver span of 7.5cm with palpable 2cm liver edge (-) gum bleeding

TH 5

HOSPITAL DAY

TH (8

DOI)

Diet as tolerated except for dark colored foods Repeat CBC w/ PC was done at 6am which revealed RBC Ct.: 5.23, Hgb: 14.60, Hct: 0.44, WBC Ct.: 9.56, Seg: 0.50, Lymph: 0.44, Mono: 0.03, Eo: 0.03, Plt: 100 Medications continued IVF was continued

TH 6

HOSPITAL DAY

TH (9

DOI)

Afebrile, conscious, weak-looking, not in cardiopulmonary distress, with good appetite BP: 90/60mmHg CR: 76/min RR: 20/min Temp: 36.9oC Whitish iris, OS (-) ROR reflex, OU Congested turbinates Hyperemic pharyngeal wall with post-nasal drip Moist lips with moist buccal mucosa (+) tenderness at epigastric area and right upper quadrant Liver span of 7.5cm with palpable 2cm liver edge (-) gum bleeding

TH 6

HOSPITAL DAY

TH (9

DOI)

Diet as tolerated except for dark colored foods Repeat CBC w/ PC was done which revealed RBC Ct.: 4.70, Hgb: 13.10, Hct: 0.39, WBC Ct.: 5.95, Seg: 0.41, Lymph: 0.48, Mono: 0.05, Eo: 0.06, Plt: 162 IVF was discontinued Patient was discharged