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Karl V. Bolintiam. JB 4 /M Filipino Roman Catholic Pasig City Informant : mother Good reliability 90%. GENERAL INFORMATION. “ Nilalagnat ” (Fever of 4 days duration). CHIEF COMPLAINT. 4 Days PTA. 3 Days PTA. 2 Days PTA. 1 Day PTA. Few Hours PTA. Unremarkable.
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JB • 4/M • Filipino • Roman Catholic • Pasig City • Informant : mother • Good reliability 90% GENERAL INFORMATION
“Nilalagnat” (Fever of 4 days duration) CHIEF COMPLAINT
Unremarkable Past Medical History
Full term • NSD • 26 year old G1P1 (1001) • Birth weight 3.2 kg • Attended by OB • No complications Birth History
(+) (-) Varicella Pneumococcal Influenza Rotavirus Hepatitis A • DPT (3) • OPV (3) • Hep B (3) • BCG • Measles • MMR (2) • HiB (3) Immunization
Breastfed until: 2 years • Formula: Bona kid • Weaning age: 6 months • No food allergies • Food preferences: cereals, banana • Current diet: rice, meat, vegetables, milk Nutritional History
At par with age Developmental History
(+) Asthma- maternal side • No other family members with same signs and symptoms 32 30 FAMILY HISTORY
Subjective Objective 38.9 C Pink conjunctiva, (-) sunken eyeballs (+) dry oral mucosa Full and equal pulses CRT < 2s Warm extremities • 4 days intermittent fever (Tmax 38.0C) • Paracetamoltemporary relief • Vomiting 1-2 episodes/day in 3 days • Poor oral intake • Abdominal pain • 3 episodes of loose watery stools Salient features
PRIMARY WORKING IMPRESSION Acute Gastroenteritis with no signs of dehydration
Dengue fever • Typhoid fever • Systemic viral illness • UTI DIFFERENTIAL DIAGNOSIS
Passage of unusually loose or watery stools • At least 3 times in a 24 hour period • Consistency is most important DIARRHEA
Home therapy to prevent dehydration and malnutrition • Give more fluids than usual • Supplemental zinc • 10-20 mg everyday for 10-14 days • Continue to feed the child • Small frequent feedings • Consult if there are signs of dehydration TREATMENT PLAN A
Oral rehydration therapy for children with some dehydration • Wt in kg x 75 mL = approxamt of ORS • do not use feeding bottles • Monitor progress • Continue to breastfeed • Zinc- following 4 hour rehydration period TREATMENT PLAN B
For patients with severe dehydration • Reassess patient every 1-2 hours, if patient is not improving, give IV drip 100 mL / kg Ringer’s Lactate TREATMENT PLAN C
Hypernatremia • Na > 150 = thirst out of proportion to signs of dehydration • Na > 165 = convulsions • Hyonatremia • Na < 130mmol/L • Lethargy, seizures • Hypokalemia • K < 3mmol/L • Muscle weakness, paralytic ileus, impaired kidney fcn, cardiac arrhythmia Electrolyte disturbances
Occurs in large epidemics that involve both children and adults • Voluminus watery diarrhea severe dehydration with hypovolemic shock • Antibiotics may shorten illness duration CHOLERA
Dysentery • Shigella • Ciprofloxacin 3 days or 5 days with another oral antimicrobial • Seen again after 2 days: • Initially dehydrated, less than 1 year old, had measles within past 6 weeks, not getting better ACUTE BLOODY DIARRHEA
Unusual cause of bloody diarrhea • Trophozoites of E histolytica containing red blood cells • or two different antimicrobials for shigella does not provide relief AMOEBIASIS
Diarrhea with or without blood what begins acutely and lasts at least 14 days • Breastfeeding prevents persistent diarrhea PERSISTENT DIARRHEA