1. By Dr khounelaphet Touphaythoune Savannakhet provincial hospiatl
Case presentation
By Dr khounelaphet Touphaythoune
Savannakhet provincial hospiatl

2. History ເດັກຍິງ ອາຍຸ 6 ປີ
ບ້ານ ໜອງຜື, ເມືອງ ນະຄອນໄກສອນ ພົມວິຫານ ແຂວງ ສະຫວັນນະເຂດ
ເຂົ້ານອນໂຮງໝໍ 16/2/19 ເວລາ 12h8’
ສົ່ງມາແຕ່ໂຮງໝໍສູນການແພດຮ່າໂນ້ຍ

3. ໄຂ້ມື້ທີ 4 + ຮາກ + ເຈັບໃນທ້ອງ
History
ໄຂ້ມື້ທີ 4 + ຮາກ + ເຈັບໃນທ້ອງ

4. Present history
ໄຂ້ຢູ່ບ້ານໄດ້ 4 ວັນ ລັກສະນະໄຂ້ຮ້ອນສູງກິນຢາລົດໄຂ້ບໍ່ລົງ, ໄດ້ ໄປກວດ ແລະ ປິ່ນປົວນຳສູນການແພດຮ່າໂນ້ຍ, 16/2/19 ໃສ່ ນ້ຳ 2ຖົງ (100ມລ), ບອກວ່າເປັນວິຕາມິນ ສົມທົບດ້ວຍອາການ ຮາກຫຼາຍຄັ້ງ (ຮາກບໍ່ດຳ), ເຈັບໃນທ້ອງ, ບໍ່ມີເລືອດເຟັນແຂ້ວຊຶມ, ບໍ່ມີຖ່າຍດຳ, ນ້ຳຍ່ຽວລ່າສຸດ 9ມ ຍ້ອນເຈັບໃນທ້ອງຫຼາຍ, ກິນດື່ມບໍ່ ໄດ້ຈຶ່ງຖືກນຳສົ່ງມາໂຮງໝໍແຂວງເວລາ 12ມ

5. Past history ແຂງແຮງດີ ບໍ່ມີພະຍາດປະຈຳຕົວ ລູກຜູ້ທີ 2/2 ວັກຊີນສັກຄົບ
ພັດທະນາການດີສົມສ່ວນຕາມອາຍຸ
ໃນຄອບຄົວບໍ່ມີໃຜເປັນພະຍາດເລືອດໄຫຼ, ພະຍາດໄຂ້ຍຸງລາຍ ຫຼື ພະຍາດອື່ນໆ

6. Physical examination
V/S: BP 80/40 mmHg strong, RR 24/min, HR 88/min strong, T 36.5 ˚C
W: 22kg
GA: Alert, vomiting 2 times, not pale, warm, CRT< 2sec, no dry lip, no dyspnea, TT(-)ve
HEENT: no microcephaly, no gum bleeding, pharynx no redness, not injected, no lymphadenopathy
Skin: no petechiae, no ecchymosis

7. Physical examination
RS: no retraction, normal breath sound, lung clear
CVS: normal S1S2, no murmur, no tachycardia
Abdomen: soft, no distention, abdominal pain on epigastrium, liver 2cm , spleen not palpable
CNS: no irritable, BBK, clonus negative, no stiff neck, Kernig's sign negative, good consciousness

8. Problem list Female 6 years old High grade fever 4 days
History of treatment with IV fluid 100ml
Vomiting, poor intake
Abdominal pain
Liver 2cm

9. Differential diagnosis
Dengue fever with warning sign
Appendicitis

10. Dengue fever with warning sign
Diagnosis
Dengue fever with warning sign

11. Investigation CBC 16/2/19 at 12h30’ Serology WBC 4,220/mm3
Test dengue (-) ve
NS1 (+) ve
IgG (-) ve
IgM (-) ve
GRA
71% Hb
13,3g/dl
HCT
41,8%
MCV 71
Blood group ( O+ )
MCH
22,5
RDW
14,8%
PLT
102,000/mm3

12. Management 16/2/19(D4) Time Vital sign Sign & Symptom Management Lab
12h38’
BP 80/40 mmHg
T 36.5˚C
RR 24 bpm/min
HR 88 bpm/min
CRT <2sec, warm
good consciousness
Vomiting 2times
Abdominal pain on epigastrium
Liver 2cm
Urine 60ml/2hr
RL 5ml/kg/hr x 2hr
v/s q 2hr
WBC 4,220/mm3
HCT 41.8%
PLT 102,000/mm3
NS1 positive
IgG (-)ve, IgM (-)ve
14h30’ – 6h00’
BP 80/50 mmHg
T 37˚C
HR 82 bpm/min
No vomiting
Abdominal pain same
↓RL 3ml/kg/hr
Total Fluid 18hr
IV 1600ml, Oral 190ml
Urine 1070ml (2.4ml/ml/hr)

13. Management 17/2/19(D5) Time Vital sign Sign & Symptom Management Lab
7h30’
BP 80/60 weak
T 36˚C
RR 30bpm/min
HR 102 bpm/min weak
CRT 3sec
Abdominal pain all
Vomiting
Cool
On Foley tube
Urine 150ml
Off RL
NSS 10ml/kg/hr
v/s q 1hr
WBC 2,420/mm3
HCT 46.7%
PLT 9,000/mm3
8h30’
BP 80/50 strong
T 37˚C
RR 25 bpm/min
HR 96 bpm/min weak
CRT 2sec
Abdominal pain
Warm
Urine 100ml
↓NSS 7ml/kg/hr
WBC 3,700/mm3
HCT 44%
PLT 32,000/mm3

14. Management 17/2/19(D5) Time Vital sign Sign & Symptom Management Lab
9h30’
BP 80/50 strong
T 37˚C
RR 24 bpm/min
HR 94 bpm/min strong
CRT 1sec
Abdominal pain all
No vomiting
Warm
Water oral 200ml
Urine 100ml
Off NSS
Continue RL 7 ml/kg/hr
10h30’
BP 80/50 weak
HR 110 bpm/min weak
CRT 2sec
Abdominal pain
Urine 0 ml
RL 5ml/kg/hr

15. Management 17/2/19(D5) Time Vital sign Sign & Symptom Management Lab
11h30’
BP 80/50 weak
T 37.5 ˚C
RR 30 bpm/min
HR 110 bpm/min strong
CRT 2sec
Abdominal pain all
No vomiting
warm
Urine 0ml
Off RL
NSS 10 ml/kg/hr
Pre crossmatch
WBC 5,070/mm3
HCT 46.8%
PLT 5,000/mm3
12h30’
BP 80/70 weak
RR 34 bpm/min
HR 120 bpm/min weak
Abdominal pain
Warm
Urine 100 ml
Off NSS
Dextran 10ml/kg/hr
WBC 4,310/mm3
HCT 45%
PLT 12,000/mm3

16. Management 17/2/19(D5) Time Vital sign Sign & Symptom Management Lab
13h30’
BP 96/60 strong
T 37.5 ˚C
RR 38 bpm/min
HR 98 bpm/min strong
CRT 1sec
Abdominal pain all
No vomiting
Warm
Water oral 20ml
Urine 100ml
↓ Dextran 7 ml/kg/hr
14h30’
BP 90/60 strong
T 38 ˚C
HR 102 bpm/min weak
↓ Abdominal pain all
Urine 200 ml
Off dextran
RL 5 ml/kg/hr
WBC 4,710/mm3
HCT 34.9%
PLT 5,000/mm3

17. Management 17/2/19(D5) Time Vital sign Sign & Symptom Management Lab
15h30’
BP 100/70 strong
T 37.5 ˚C
RR 38 bpm/min
HR 90 bpm/min strong
CRT 1sec
↓ Abdominal pain all
No vomiting
Warm
Water oral 20ml
Urine 150ml
Continue RL 5 ml/kg/hr
16h30’
BP 80/50 weak
T 37.8 ˚C
HR 102 bpm/min weak
Urine 100 ml
WBC 4,580/mm3
HCT 37%
PLT 2,000/mm3

18. Management 17/2/19 (D5) Time Vital sign Sign & Symptom Management Lab
17h30’
BP 100/60 strong
T 37 ˚C
RR 32 bpm/min
HR 98 bpm/min strong
CRT 1sec
↓ Abdominal pain all
No vomiting
Warm
Urine 100ml
↓ RL 3 ml/kg/hr
18h30’ – 20h30
BP 90/60 strong
HR 100 bpm/min
Urine 220 ml
Continue RL 3 ml/kg/hr x 2hr

19. Management 17-18/2/19(D5-D6) Time Vital sign Sign & Symptom Management
Lab
21h30’ – 6h00’
BP 80-90/50-60 strong
T ˚C
RR bpm/min
HR bpm/min strong
CRT 1sec
No abdominal pain
No vomiting
Warm
Water oral 80ml
Urine m /hr
↓ RL 1.5 ml/kg/hr x 10hrs
V/S q 3hr
CBC at 21h00
WBC 5,660/mm3
HCT 39.8%
PLT 6000/mm3
CBC at 6h00
WBC 5,000/mm3
HCT 40.7%
Total Fluid: Input 2116ml ( IV 2064ml , Oral 110ml )
Out put 1860ml = 3.5ml/kg/hr

20. Management 18/2/19 (D6) Time Vital sign Sign & Symptom Management Lab
7h00’
BP 90/60 mmHg strong
T 37 ˚C, RR 53 bpm/min
HR 72 bpm/min
CRT 1sec
Good appearance
Warm
want to have breakfast
Off IV
Start furosemide 1MKD
V/S q 6hr
8h00’
BP 100/70 strong
T 37 ˚C, RR 45 bpm/min
HR 76 bpm/min
Furosemide 1MKD q 6hr then off 20/2/19 and discharged
Blood Chemistry CBC before discharged
K 4.3 mmol/L WBC 7,180/mm3
Na 139 mmol/L HCT 39.7%
Cl 108 mmol/L PLT /mm3
BUN 30 mg/dl
Cr 0.57 mg/dl
Calcium 7.7 mg/dl
Glycemia 57.7mg/dl
Alb 2.2 g/dl

21. Dengue fever with compensated shock
Final diagnosis
Dengue fever with compensated shock

22. Thank You