Case Scenario

Sonali Dinesha

11 yrs

From Mount Lavinia Admitted on 09/06/2010

Fever 3 days Abdominal pain 3 daysHeadache

Sonali has been apparently well until 3 days before. Has developed fever high grade intermittent No chills respond to paracetamol . She also has had moderate abdominal pain with mild dysuria but no frequency or haematuria . She has not had any vomiting No bleeding tendencies

O/E Weight 38

General- Febrile alert, hydration good. Throat congested B/L ears normal , no lymphadenopathy , CRFT < 2 sec. Hess’s test negative CVS – PR – 80 bpm, good volumeBP 100/60Heart Dual RhythmNo murmurs RS /Lungs clear , Vesicular breathing Abdomen – Liver 1 cm / tender

Q) What is your probable diagnosis/differential diagnosis ?

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Q) What investigations would you do?

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Q) Is it DF/DHF ? Which phase ? ------------------------------------------------------------------------------------------------------------------------

Q) How do you manage ? How much fluids would you recommend? IV ? Oral ? Calculate the requirement ? how often would you monitor ? Which monitoring chart would you use at this stage ? ( FBC- 3500 N 30 % , Platelets 160000, PCV 35%)

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Q) When would you do a another FBC ?

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Q) Child passed 350 ml urine at 8 pm after 6 hrs of admission What is the UOP ml/kg/hr. Mother says she passed urine just before she was admitted as well.

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9 pm ward round – findings are

Febrile alert, hydration goodCVS – PR – 80 bpm, good volumeBP 100/70Heart Dual RhythmNo murmurs RS /Lungs clear , Vesicular breathing Abdomen – Liver 1 cm / tender

Ward PCV – 37

Q) What is your plan now?

Q)Child passed 240 ml urine at 3am. What is the UOP ml/kg/hr

Q)Fluid intake Oral fluids 50 ml kunjee at 3pm/ Oral fluids 100 ml milk at 8 pm./ Water 80 ml What do you think of his oral fluid intake ? adequate/ too much? What do you think of his UOP

Following day morning ward rounds findings

General- Afebrile alert, hydration good. CRFT < 2 sec Hess’s test positive

CVS – PR – 80 bpm, good volumeBP 100/60Heart Dual RhythmNo murmurs RS /Lungs clear , Vesicular breathing Abdomen – Liver 2 cm / tenderFBC- WBC/DC 1.7 x 103 N 32% L 65% Hb 12.2 PCV 36.5 Platelet count - 135000

SGOT- 53.9SGPT- 28

Q) What can you say now ?

When would you do a another FBC ?

Q)10/6 4 pm FBC- WBC/DC 1.2 x 103 N 34 % L 66 % Hb 12.2 PCV 41 Platelet count - 83000

Q) What can you say now ? What would you do ?

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Q) 10/6 – 8pm Inward PCV – 45% Passed urine 8 pm 110 ml – ( 0.4ml/Kg/hr)What would you do now ?-------------------------------------------------------------------------------------------------------------------------

Q) 2 amPCV 46 %

Q)6am PCV 48 %PP- 15BP 100/85

Q)8am When the Reg does the round

BP 70/50PP- 15Cold and clammyPCV 40Pulse120

Q) What do you do now ?

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