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CASE REPORT

CASE REPORT. CCMDDHF. Baby Fathima 5 year old girl from Kalpitiya developed high grade fever on 28 th of march associated with -vomiting 8-10 times -headache -cough

brett-nolan
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CASE REPORT

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  1. CASE REPORT CCMDDHF

  2. Baby Fathima 5 year old girl from Kalpitiya developed high grade fever on 28 th of march associated with -vomiting 8-10 times -headache -cough She didn’t had loose stools or bleeding menifestations

  3. 29th of march- got treatments from Kalpitiya hospital - didn’t do blood investigatons • But the baby was not improved. Persistant vomiting was there.

  4. 30th – taken treatments from privet sector. given-PCM 500mg tds -domperidone 5mg tds -amoxycillin 250mg tds -prednisolon 2.5 mg tds

  5. 31st- continue the same drugs, but the condition was not improved. Night started to vomit again it was blood stained. Baby was vomited 7-8 times

  6. 1st of April -2.30 am- patient admited to the kalpitiya hospital - normal saline 300ml given over 6 h -8.00am- patient transfer to Puttlam hospital

  7. In Puttlum • Hx-fever +, cough+, no vomiting or loose stools, no bleeding menifestationsafter admission, UOP REDUCED • Ex-patient drowsy, less active,ill looking, afebrile, BP-100/50mmHg, PR-100bpm,CRFT<2 sec • Ix-FBC-WBC-7500 CBS- 25mg/dL -PLT-80000 SGOT>500 -PCV-39 SGPT>500 -Hb-12.2

  8. Mx – IV N. saline+ 5% dextrose 3.5ml/kg/hr IV vit k 10mg stat IV 20% dextrose bolus??????

  9. 11AM • Catheterized the patient UOP- 300ml=1.8ml/kg/hr since 8pm 31st march • Contacted Dr. LakKumar Fernando, clinical head of CCMDDHF and arrange the transfer of the patient to Negombo.

  10. 12.30 PM • CCMDDHF contacted Puttlam Hospital answer- patient is preparing for the transfer

  11. 2.00pm • Contacted Putlum Hospital Patient already transfered

  12. 3.15pm • Patient admited to the CCMDDHF • Hx-no fever, no blood stain vomiting, no loose stools, no cough c/o-drowsy and irritability of the patient • Ex-ill looking, drowsy, irritable child, afebrile GCS- 15/15 BP-110/76mmHg PR-112bpm

  13. CRFT<2 sec abd-soft lungs-clear

  14. What we have done • Sent blood investigations FBC, AST, ALT, NS1, GROOPING &DT, PT/INR, SERUM Ca, Stool for occult blood • Did a CBS- 48mg/dL given iv 25% dextrose 1 vial stat • Start iv N. saline+5% dextrose

  15. fluids • Height- 107cm • Weight- 13kg • IBW- 18kg • Maintenance- 3.7mi/kg/hr • M+5%- 2.9mi/kg/hr=37cc/hr we have started 26cc/hr

  16. USS- PT+PF=0.6cm MP=NO FLUIDS FF in pelvis=0.4cm R/S PE=0.42cm L/S PE=0.2cm • NS1- NEGATIVE ON D4

  17. DRUGS • PCM 200mg 6hrly sos • Evoline forte 5ml tds • Fomotidine 10mg bd • Domperidone 5mg tds • Tranaxamic acid 250mg tds • Iv vit k 5 mg daily • Metranidazole 200mg tds • Lactulose 5ml tds • Iv cefuroxime 250mg tds

  18. 4.30pm • FBC- WBC- 6740 Hb - 12mg/Dl PLT - 74000 HCT - 35 • Patient seen by consultant peadiatrician BP- 107/77mmHg PR- 86bpm - IV Calcium gluconate 8ml over 40 mints

  19. 6pm • VBG has been done pH -7.334 pCO2 -26.7mmHg pO2 -35mHg HCO3 -14.4mmol/L

  20. 7PM • SGOT-19740 • SGPT-10560 • Inform VP over the phone -give dextran ½ bolus -correct acidosis -find out fresh blood

  21. INVESTIGATIONS

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