Académique Documents
Professionnel Documents
Culture Documents
Morbidity Conference
September 24, 2009
General Data
IDJ
34 years old, Female
Dulonan, Arevalo, Iloilo City
August 3, 2009
2:30 PM
Chief Complaint
Fever
History of Present Illness
2 days PTA
◦ Low grade, intermittent fever
◦ CBC requested
CBC
Hemoglobin= 132
Hematocrit= 0.41
RBC= 4.59
WBC=3.6
Segmenters= 0.80
Lymphocytes= 0.18
Eosinophils= 0
Monocytes= 0
Basophils= 0.02
Platelet count= 216
4 hours PTA
◦ Persistence of low grade, intermittent
fever
◦ Repeat CBC – leukopenia and
thrombocytopenia
◦ No bleeding problems
CBC
Hemoglobin= 146
Hematocrit= 0.45 ↑
Previous:
Hem oglobin= 132 RBC= 5.15
Hem at ocrit = 0.41
WBC=2.3
RBC= 4.59
WBC= 3.6 Segmenters= 0.54
Segm ent ers= 0.80
Lymphocytes= 0.45
Lym phocyt es= 0.18
Eosinophils= 0 Eosinophils= 0.01
Monocyt es= 0
Basophils= 0.02
Monocytes= 0
Plat elet count = 216 Basophils= 0
Platelet count= 78
Past Medical History
Non hypertensive
Non diabetic
Non Asthmatic
No history of bleeding dyscrasias
No history of PTB
No trauma/ surgical procedures
Allergy to crustaceans
Personal History
Works as a school employee
Non smoker, non alcoholic beverage
drinker
Fa m ily H ist or y
Unrem arkable
Physical Examination
Ambulatory, conscious, coherent, oriented,
not in cardiopulmonary distress
BP=90/70 mm Hg CR=75 RR=23 Temp=36 C
Weight= 71 kg Height= 5’2
Anicteric sclerae, pink palpebral
conjunctivae
Good skin turgor, moist lips and buccal
mucosa
No neck vein engorgement, no cervical
lymphadenopathy, no tonsillopharyngeal
congestion
Adynamic precordium, PMI at 5th ICS left
midclavicular line, S1 and S2 normal,
regular cardiac rate and rhythm, no
murmurs
Symmetrical chest expansion,
bronchovesicular breath sounds, no rales,
no wheezes
Flat abdomen, normoactive bowel sounds,
soft, non-tender, no palpable mass, non-
palpable liver edge and spleen, Liver
span= 10cm MSL, 6cm MCL
Grossly normal extremities, full peripheral
pulses, no edema
Negative tourniquet test
Admitting Impression
Dengue Fever
Dengue Clinical Syndromes
Undifferentiated fever
Classic dengue fever
Dengue hemorrhagic fever
Dengue shock syndrome
Cent er for Disease Cont rol. Dengue: Clinical and Public Healt h
Aspect s, 2008
Undifferentiated Fever
May be the most common manifestation of
dengue
Prospective study found that 87% of
students infected were either
asymptomatic or only mildly symptomatic
Other prospective studies including all age-
groups also demonstrate silent
transmission
Laboratories:
◦ CBC
◦ Serial platelet count Q4H
◦ Dengue Rapid test
◦ Typhidot
◦ APTT, Protime
◦ Chest X-ray PA view
◦ ECG
◦ Urinalysis
CBC
Hemoglobin= 146
Hematocrit= 0.45
RBC= 5.15
WBC=2.3
Segmenters= 0.54
Lymphocytes= 0.45
Eosinophils= 0.01
Monocytes= 0
Basophils= 0
Platelet count= 78
Dengue Rapid Test: IgM positive
IgG positive
◦
Chest X-ray
ABG
FIO2= 52%
pH= 7.35
pCO2= 28
pO2= 138
HCO3= 18
sO2= 99%
pAO2/FI02 ratio=265.38 mm Hg
Required FIO2= 22%
HCO3 deficit= 56.8 meqs in 24 hours
Definition Criteria for ALI and ARDS
Criteria for ALI
◦ Acute in onset
◦ Oxygenation: A partial pressure of arterial oxygen to
fractional inspired oxygen concentration ratio < 300 mm
per Hg (regardless of PEEP)
◦ Bilateral pulmonary infiltrates on chest radiograph
◦ Pulmonary artery wedge pressure < 18 mm per Hg or no
clinical evidence of left atrial hypertension
Criteria for ARDS
◦ Acute in onset
◦ Oxygenation: A partial pressure of arterial oxygen to
fractional inspired oxygen concentration ratio < 200 mm
per Hg (regardless of PEEP)
◦ Bilateral pulmonary infiltrates on chest radiograph
◦ Pulmonary artery wedge pressure < 18 mm per Hg or no
clinical evidence of left atrial hypertension
Pathogenesis of ALI
Hypovolem i
a
Profound shock
28 March 2005.
BLOCKED BY SEPSIS
PCO2= 32
PO2= 59
HCO3= 14
So2= 83%