pp dhf english.pptx

8/14/2019 pp DHF english.pptx

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Name : F.S.K

Age : 53 y.o

Sex : Female

Date of Admission : 7 March 2010



Chief Complaint

Fever since 3 days before hospital admission.

Present Illness

The patient came to Siloam Kebon Jeruk hospital with a

chief complaint of fever since 3 days before hospitaladmission. The fever is continuosly. The patient alsocomplains of weakness, loss of appetite, nausea withoutvomiting, and numbness in both legs. The patient has noproblem on urinating and defecating. According to the

patient, she experience no features of cough or flu. Thepatient has not been travelling out of town and none of herneighbours or family member suffer from the same sickness.The patient admits that she consumed panadol for herfever with no effect. She also had a Diabetes Mellitus type II

since 5 years ago, and is on medication glucovance 2.5 mgtwice daily (morning and afternoon).



Past Medical History

The patient was previously hospitalized in the samehospital on 2009 with complaint of numbness by the

hospital’s neurologist. The patient deny any kind ofoperation surgery and has no allergies to any type ofdrugs or food.

Family History

None of this patient’s family member is experiencingthis sort of sickness. Her uncle also have DiabetesMellitus type II. No family member has a history of

hypertension and heart disease.

Social history

This Patient comes from a middle economical family.

There is no history of smoking and alcoholic drinks.



General State : Moderately ill

Consciousness : Compos Mentis

GCS : E4M6V5 Blood pressure : 100/60

Pulse : 82 x/minute

Temperature : 37.5o

C Respiration : 22 x/minute



Skin

Warm and dry, turgor is adequate, color is normal.

There is no icterus, petechia, purpura, rash, or unusual

pigmentation noted.

Head

Normocephaly and no sign of traumatic; no lesions noted.

Hair short and black, the face is symmetrical, no edema.

Eyes

Eyelids ptosis (-), exopthalmos (-), laceration (-).

cornea is without lesion, no secret.

anemic conjunctiva (-), Scleral icterus (-),

pupils are equal, measuring approximately 3 mm-3 mm indiameter, round, reactive to light; direct light reflex (+,+),indirect light reflex (+,+).

Extraocular movements are conjugated, no signs ofNystagmus or strabismus.



Ears

Normal in appearance, auditory canal appear cleanand without lesion,

hearing is adequate, pain upon tragus’s pressure (-)

Nose

Septum appears to be within normal limits andwithout deviation. Nasal mucosa appear pink withoutany abnormal discharge. No nasal polyp or otherlesion are noted, frontal and maxillary sinuses arenontender.

Mouth

Lips are symmetris; no cyanosis or pallor. Surface israther dry.

Buccal mucosa is normal in appearance.



Thoraxinspection

Symmetrical, normal intercostals space, no enlargement nor

shrinkage, no venectation, no tumor. Movement isaccordingly to respiration. Apical impulse not visible.

Palpation

No signs of mass, tactil fremitus equal bilaterally.

Percussion

Lung fields are resonant throughout.

Lung – Liver border : right midclavicular line ICS V

auscultation

Lung : vesicular breath sound, ronchi (-/-), wheezing (-/-)

Heart : S1S2 are regular, murmur (-), gallop (-).



Abdomen

Inspection Abdominal wall is symmetric, normal size and contour. There

are no vein dilatations. Abdominal wall moves accordingly to respiration.

Palpation Abdominal wall is supple, no abdominal distention or masses.

Pain on epigastric pressure is present, no pain on otherabdominal field. Liver : not palpable. Spleen : not palpable Kidney : No CVA tenderness

PercussionTympanic on all four abdominal quadrants.

Auscultation Normoactive bowel sounds.



Extremity

Both hands and feet are normal in sizeand shape

Acrals are warm, no sign of cyanotic

No edema on all four extremities

No tremor on all four extremities

Anogenitalia

Not examined.



Hb 10.1 g/dL

Leucocyte 6.4 10^3/µL

Hematocrite 29.7 %

Platelet 140 10^3/µL

Fasting Blood Glucose 175 mg/dL

Blood Gluc. 2pp morning 276 mg/dL

Blood gluc. 2pp afternoon 257 mg/dL

Blood gluc. 2pp evening 121 mg/dL

Anti dengue IgG Positive

Anti dengue IgM Positive



Date Haemoglobin Haematocrite Platelet Leucocyte

7/3 12.8 36.5 197 6.3

10/3 10.8 31 160 8.9

11/3 10.1 29.7 140 5.1

12/3 9.6 28.4 147 5.1



7/3 9/3 10/3 11/3

Fasting blood glucose 294 133 175

Blood gluc. 2pp morning 239 233 252 276

Blood gluc. 2pp afternoon 250 228 342 257

Blood gluc. 2pp evening 265 190 271 121



A patient, female, 53 y.o., came to Siloam Kebon Jeruk hospital witha chief complaint of fever since 3 days before hospital admission.

The fever is continuosly. The patient also complains of weakness, lossof appetite, nausea without vomiting, and numbness in both legs.The patient has no problem on urinating and defecating. Accordingto the patient, she experience no features of cough or flu. Thepatient has not been travelling out of town and none of herneighbours or family member suffer from the same sickness. The

patient admits that she consumed panadol for her fever with noeffect. She also had a Diabetes Mellitus type II since 5 years ago,and is on medication glucovance 2.5 mg twice daily (morning andafternoon).

Physical examination showed relatively stable hemodynamic with

blood pressure : 100/60, pulse : 82 x/min, temperature : 37.50

C,respiratory : 22x/min. Lips looked dried, present of pain on epigastricpressure.

Significant features found on laboratory test are; Haemoglobin 10,1g/dL; Haematocrite 28.7%; platelet count : 140.000/μl, The dailycurve on blood glucose shown hyperglycemic, on serologic test

shown that antidengue IgM and IgG are positive



1. Dengue Haemorrhagic Fever (DHF)

2. DM type II

3. Polyneuropathy diabeticum



DHF is diagnosed based on findings duringanamnesis & laboratory finding such as :

Fever since 3 days before admission

GIT symptoms (nauseous) Lab ↓ platelet 147.000/μl

-- Anti dengue IgM (+)

Differential Diagnosis :

Typhoid fever



Therapy :

Medication:

ORAL Paracetamol (Sumagesic ® 500mg, 3 x 1)

IV

Pantoprazole (Pantozol® 40mg IV, 1 x 1)

Ondansetron (Narfoz® 4 mg IV, 3 x 1)

FLUID

Ringer Asering 30 drops per minute.

Nonmedication:

Bedrest



Diabetes Mellitus is diagnosed based on findings during anamnesis,

laboratory finding such as : The patient having Diabetes Mellitus since 5 years ago and

consume glucovance 25 mg twice daily.

Fasting Blood glucose 175 mg/dL

Blood Glucose 2pp in the morning 276 mg/dL

Blood glucose 2pp in the afternoon 257 mg/dL

Theraphy :

Medication:

ORAL : Glimepiride (Amaryl® 1mg 1x1)

SC : insulin (actrapid® 3x8 U)

Non medication :

Education & motivation to exercise

Control the food with low glucose



Polyneuropathy diabeticum is diagnosed based on

findings during anamnesis, physical examination such as:

Hipestesia and parastesi

Theraphy :Medication:

ORAL : Anti neuropathy pain (Lyrica® 75 mg 1x1)

Nootropik&neurotonik (Arcalion® 200mg 2x1)

IV : Mecobalamin (Methycobal® 1x1)

Non medication :

fisioterapi



Ad vitam : dubia ad bonam

Ad functionam : dubia ad bonam

Ad sanationam : dubia ad bonam

pp dhf english.pptx

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