Karl V. Bolintiam

1. Karl V. Bolintiam

2. JB • 4/M • Filipino • Roman Catholic • Pasig City • Informant : mother • Good reliability 90% GENERAL INFORMATION

3. “Nilalagnat” (Fever of 4 days duration) CHIEF COMPLAINT

4. 4 Days PTA

5. 3 Days PTA

6. 2 Days PTA

7. 1 Day PTA

8. Few Hours PTA

9. Unremarkable Past Medical History

10. Full term • NSD • 26 year old G1P1 (1001) • Birth weight 3.2 kg • Attended by OB • No complications Birth History

11. (+) (-) Varicella Pneumococcal Influenza Rotavirus Hepatitis A • DPT (3) • OPV (3) • Hep B (3) • BCG • Measles • MMR (2) • HiB (3) Immunization

12. Breastfed until: 2 years • Formula: Bona kid • Weaning age: 6 months • No food allergies • Food preferences: cereals, banana • Current diet: rice, meat, vegetables, milk Nutritional History

13. At par with age Developmental History

14. (+) Asthma- maternal side • No other family members with same signs and symptoms 32 30 FAMILY HISTORY

15. STAKEHOLDER ANALYSIS

16. PERSONAL-SOCIAL HISTORY

17. REVIEW OF SYSTEMS

18. REVIEW OF SYSTEMS

19. REVIEW OF SYSTEMS

20. REVIEW OF SYSTEMS

21. PHYSICAL EXAMINATIon

22. PHYSICAL EXAMINATION

23. PHYSICAL EXAMINATION

24. PHYSICAL EXAMINATION

25. Subjective Objective 38.9 C Pink conjunctiva, (-) sunken eyeballs (+) dry oral mucosa Full and equal pulses CRT < 2s Warm extremities • 4 days intermittent fever (Tmax 38.0C) • Paracetamoltemporary relief • Vomiting 1-2 episodes/day in 3 days • Poor oral intake • Abdominal pain • 3 episodes of loose watery stools Salient features

26. PRIMARY WORKING IMPRESSION Acute Gastroenteritis with no signs of dehydration

27. Dengue fever • Typhoid fever • Systemic viral illness • UTI DIFFERENTIAL DIAGNOSIS

28. COURSE IN THE WARDS

29. DAY 1 of Hospitalization

30. DAY 2 of Hospitalization

31. DAY 3 of Hospitalization

32. discussion

33. Passage of unusually loose or watery stools • At least 3 times in a 24 hour period • Consistency is most important DIARRHEA

34. CLINICAL TYPES

35. Assessment of dehydration

36. Home therapy to prevent dehydration and malnutrition • Give more fluids than usual • Supplemental zinc • 10-20 mg everyday for 10-14 days • Continue to feed the child • Small frequent feedings • Consult if there are signs of dehydration TREATMENT PLAN A

37. Assessment of dehydration

38. Oral rehydration therapy for children with some dehydration • Wt in kg x 75 mL = approxamt of ORS • do not use feeding bottles • Monitor progress • Continue to breastfeed • Zinc- following 4 hour rehydration period TREATMENT PLAN B

39. Assessment of dehydration

40. For patients with severe dehydration • Reassess patient every 1-2 hours, if patient is not improving, give IV drip 100 mL / kg Ringer’s Lactate TREATMENT PLAN C

41. Hypernatremia • Na > 150 = thirst out of proportion to signs of dehydration • Na > 165 = convulsions • Hyonatremia • Na < 130mmol/L • Lethargy, seizures • Hypokalemia • K < 3mmol/L • Muscle weakness, paralytic ileus, impaired kidney fcn, cardiac arrhythmia Electrolyte disturbances

42. Occurs in large epidemics that involve both children and adults • Voluminus watery diarrhea  severe dehydration with hypovolemic shock • Antibiotics may shorten illness duration CHOLERA

43. Dysentery • Shigella • Ciprofloxacin 3 days or 5 days with another oral antimicrobial • Seen again after 2 days: • Initially dehydrated, less than 1 year old, had measles within past 6 weeks, not getting better ACUTE BLOODY DIARRHEA

44. Unusual cause of bloody diarrhea • Trophozoites of E histolytica containing red blood cells • or two different antimicrobials for shigella does not provide relief AMOEBIASIS

45. Diarrhea with or without blood what begins acutely and lasts at least 14 days • Breastfeeding prevents persistent diarrhea PERSISTENT DIARRHEA