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RT, 5/M

RT, 5/M. RCT, 5/M from Paranaque admitted for the first time for diarrhea and vomiting. HISTORY OF PRESENT ILLNESS. 2 days PTA: (+) increased sleeping time (+) lethargic 1 day PTA  loose watery stool, non- mucoid, non-bloody

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RT, 5/M

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  1. RT, 5/M

  2. RCT, 5/M from Paranaque admitted for the first time for diarrhea and vomiting

  3. HISTORY OF PRESENT ILLNESS • 2 days PTA: (+) increased sleeping time (+) lethargic • 1 day PTAloose watery stool, non- mucoid, non-bloody >5x/day ½ cup/episode non-projectile vomiting >5x/day  high grade fever

  4. HISTORY OF PRESENT ILLNESS • 1 day PTA brought to local hospital  persistence of symptoms  3 episodes GTC seizures 5 mins duration, 1 min interval, no regain in consciousness Transferred to PGH

  5. REVIEW OF SYSTEMS (+) cough/colds x 1 month duration (-) DOB (-) chest pain (-) ab pain (-) urinary changes (-) polyuria (-) polyphagia (-) polydipsia (-) rashes (-) behavioral changes

  6. PMHx: (+) typhoid fever – 2006 FMHx: (+) PTB – grandfather tx for 6 mos 2007 (+) liver Ca – grandmother ImmHx: unknown to informant BMHx: Born FT to a ? Yo G1 at a local hospital Devt Hx: at par with age P/SHx: Pt is the eldest of 2 siblings. Parents separated when he was 2 yo Lives with maternal grandparents Drinking water is from the faucet

  7. PHYSICAL EXAMINATION -ER - received unarousable - BP 80/40 HR 110 RR30 febrile - anicteric sclerae, pink conj, (+) sunken eyeballs - ECE, (+) course crackles, (-) rales/wheezes -AP, distinct heart sounds, NRRR, murmur - fair pulses, pink nailbeds, (-) cyanosis/edema

  8. PHYSICAL EXAMINATION -ER (+) spastic extremities with opisthotonos pupils 3-4 mm SRTL, (-) facial asymmtetry, (+) drooling withdraws to pain DTR +++ on all extremities, (+) babinski

  9. Initial Working Impression AGE with severe signs of Dehydration Acute symptomatic seizure prob secondary to 1) metabolic 2) CNS infection (TB, bacterial) Community Acquired Pneumonia r/o sepsis

  10. COURSE AT THE ER

  11. Infectious/Neurologic P:Dx: CBC BUN, Crea, Na, K, Cl, Ca, Mg, RBS, AST, ALT, Ck-MB blood CS, ETA GS/CS PT/PTT 12LECG U/A CXR APL Cranial CT scan Lumbar tap, HSV, Jap B titers Tx: Pen G (200,000) Chloramphenicol (100) t/s Ceftriaxone  Acyclovir Pb (20) as LD then (5) as MD

  12. Infectious/Neurologic P: intubated ET5 L14 given total 80cc/kg pNSS Dopamine (10), Dobutamine (10) started given 5cc/kg D10W given O2 support at 5-6LPM IVF: D50.9NaCl 660 cc (30cc/kg x 30 mins) then, 195cc/hr (70cc/kg x 5 hrs)  FM: 58cc/hr

  13. COURSE IN THE WARDS

  14. INFECTIOUS/NEUROLOGIC S/O : still with hypotensive episodes (70/40) : (+) melena (+) coffee ground material/NGT 12LECG: (-) low voltage QRS

  15. Infectious/Neurologic

  16. Infectious/Neurologic

  17. Infectious/Neurologic A: AGE with severe signs of Dehydration Acute symptomatic seizure prob sec to 1) Suppurative Meningitis 2) Salmonella/Shigella Meningitis 3) Viral encephalitis r/o sepsis CAP

  18. Infectious/Neurologic P:Tx: Vit. K (1) Omeprazole (0.8) Dopamine (20) , Dobutamine (20) Epinephrine (1) Ceftriaxone (100)  Pen G + Chloramphenicol IVF: D50.9NaCl (FM+100%) For BT of FFP  DNR directive

  19. Referred for HR = O DNR directive noted Pronounced 5:15 PM Post mortem care rendered

  20. PCOD: septic shock

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