CLINICAL CONFRENCE

PICU DIVISION
(New Case)
June 10nd, 2023

Dhody Setiamal,Ayi Suwarayi/ Junior

L.M.Isvan Davis, St. Huzaifah,Nita Anugerawati N/Madya
Desi Nandiyarizky, Min Ayatina, Nurfajrin Utami, M. Rifani/Senior
 PATIENT IDENTITY
A.H, 7 month
MR Number 1025524
Date of Birth Nov 05th, 2022
Admission Date June 10th, 2023

MEDICAL DIAGNOSIS
• Acute respiratory distress syndrome
• Post seizures ec causa suspected meningoencephalitis
• Community-acquired pneumonia
Chief Complaint
HISTORY TAKING
Seizure
History of Present Illness
A 7 month old boy referred from morowali hospital with a diagnosis of post seizure et causa
suspek meningoensefalitis

no fever. History of fever 7 days ago. Fever is not continuous, fever relief with paracetamol.
No seizure, history of seizure 1 weeks ago, 2 times in one day, less than 5 minutes, general
seizure, seizure without fever. After seizure sleep. Next day seizure 1 times, less than 5
minutes, seizure without fever, after seizure consious.
No cough, shortnes of breath
No vomiting.
No cough, no shortness of breath.
No vomiting. Poor appitide
Urination normal
Defecation normal
 HISTORY TAKING
Mother with second child pregnancy at 27 years old, mother routinely controls doctors, reg-
ularly consumes vitamins, no history of hypertension and diabetes mellitus and vaginal dis-
charge during pregnancy.

Birth history
Child born section secarea, full term, crying immediately, Apgar Score unknown, birth
weight 3400 gram,.

Breastfeeding History
Breastfeeding until 1 weeks.
 HISTORY TAKING
No history of previous seizures
No family history of seizures
history of previous trauma there were 3 days before the seizure, the child fell from the mat-
tress 30 cm high, hit his head, the child was conscious after falling, no vomiting
no history of fever > 2 weeks
no history of cough > 3 weeks
no history of contact with tuberculosis sufferers or old cough sufferers
no history of contact with smokers
no history of weight loss
No history of allergies
No history of asthma

History of being treated at morowali Hospital for 5 days and receiving dexametason/intra-
venous, cefriaxon/intravenous, Paracetamol/intravenous, dexamethasone/intravenous, ran-
itidine/intravenous
 PHYSICAL EXAMINATION
Vital Sign
General condition: Severe illness /
severly wasted/ GCS 10 E4M6V5
Heart Rate : 135 times/min
Temperature : 37 °C
Respiration Rate : 52 times/min
SpO2 : 99 % with nasal canul
Anthropometry
Body weight : 8,7 kg
Height : 71 cm
Head Circumference : 45,5 cm (42-49 cm)
Weight for Height : between – 2sd and median (good
nourished)
Height for Age : – 2sd and median (good stature)
Weight for Age : –2sd and median ( normoweight)
Head Circumference : 45,5
cm (42-49 cm)
Weight for Height : 38/36x100%= 105 % (good nourished)
Height for Age : 142/162x100%=87,6% (normal
stature)
Weight for Age : 38/53x100%= 71,6% (underweight)
 History of vaccine
Month Years
Vaccine
N 0 1 2 3 4 5 6 7 8 9 12 15 18 24 3 5 6 7 8
ot
gi
ve
n
Hep B v v V v
BCG V
DPT v v V
Hib V v v
OPV v v v V
IPV v

Measles v
Rotavirus V
Influenza V
Japanese V
Encephali-
tis

PCV V
Varicella V
Hepatitis A V

Typhoid V
PHYSICAL EXAMINATION
No pallor, no jaundice No murmur
No lymphadenopathy Abdomen
No Hyperemic pharynx Normal peristaltic sound
T1-T1 tonsils, not Hyperemis Liver and Spleen was not palpable

Pulmonary Ekstremity
vesicular breath sounds No edem
Minimal Ronkhi in booth lungs CRT <3 second
,No wheezing

Cardiovascular
Pure regular I / II heart sound,
Tuberculosis Score
Contact : 0
Mantoux : not yet
Nutrition : 0
Fever: 0
Cough : 0
Lymphadenopathy : 0
Joint swelling : 0
Chest X-ray: 0. Total: 0 not yet mantoux
PHYSICAL EXAMINATION
Consciousness GCS E4V1M5 absent 
Cranialnerves:
Meningeal stimulation
Nerve I: difficult to evaluate signs: positif
Nerve II: pupil round isocor,
diameter 2.5/2.5 mm,
positive light reflex Motor
Nerves III, IV, VI: difficult to Strength: difficult to
evaluate evaluate
Nerve V: positive corneal Tonus: normal
reflex (normal)
Physiological reflexes:
Nerve VII: no facial paresis normal
Nerve VIII: difficult to Pathological reflexes:
evaluate (normal)
Babinsky negative
Nerves IX, X, XI: swallowing
reflex was present Sensibility and
autonomic nervous
Nerve XII: tongue deviation system: difficult to
evaluate
 LABORATORY FINDING
Morowali Wahidin
Laboratory Normal Value
04/06/2023 10/06/23
Hb 12 11,5 12.0 – 16.0 gr/dL
WBC 5.600 10.100 4.0 – 10.0/μL
150.000 – 400.000/
PLT 186.000 180.000
mm3
MCV 75,2 75 80 -100 μm3
MCH 24,2 25 27 - 32 Pg
%NEUT 53,9 52 – 75 103/μL
%LYMPH 29,6 20 – 40 103/μL
%MONO 13,1 2 – 8 103/μL
 Wahidin
Laboratory Normal Value
10/06/23

Ureum 8 10 - 50 mg/dl

Creatinine 0,27 <1.3 mg/dl

SGOT 779 < 38 u/l

SGPT 818 < 41 u/l

Albumin 3,3 3.5 – 5.0 mg/dl

136-145
Natrium 142

Kalium 5,4 3,5-5,1

Clorida 114 97-111

Thorax X-Ray Wahidin hospital/
10/06/2023
Impression:
- normal
Radiology
finding

Ct scan Head with contrast of wahidinHospital 10/06/2023

Impression:
- Widening of the anterior bifrontal interhemispheric CSF space and frontotemporal
craniocortical region bilaterally suspected benign enlargement subarachnoid
space in infancy (BESSI)
- Persistent cavum veli interpositi
- Cephalic index : 93.6 (ultrabrachycephalic)
 ASSESMENT
• Fever
• seizure
• Elevated enzyme transminase
 Working diagnosis
• Acute respiratory distress syndrome
• Post seizures ec causa suspected meningoencephalitis
• suspected benign enlargement subarachnoid space in
infancy (BESSI)
• Community-acquired pneumonia
 Fluid requirement ( holiday segar)
treatment
870 cc/24 hours
Enteral : 8 x 20 cc
Parenteral : Infusion dextrose 29 cc/hours/iv
 1)Meropenem 40 mg/kgbw = 350 mg/8 hours/intravenous
 1)Amikasin D1 25 mg/kgbw= 200 mg/24 hours/intravenous
Next day 18 mg/kgbw = 150 mg/24 hours/intravenous
- Phenitoin 35/12 jam/intravenous
- - urdafalk 100 mg/8 hours/oral
 Paracetamol/intravenous 
 Planning
 Consult to neuro surgery for treatment benign enlarge-
ment subarachnoid space in infancy (BESSI)

 
THANK YOU