Case Report

Complex febrile seizure ec Dengue Fever

MAKMUR SEJATI
I4061172057

Consultant : dr. Hilmi K Riskawa, Sp. A, M. Kes

 F, boys 11 Months, with medical number of 156933, was hospitalized in
Dahlia’s room of grade III Kartika Husada’s hospital, March 26th to April
02nd 2019

 Mayor complaint : seizure

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 Patients come with complaints of seizure since 2 hours before entering
the hospital, According to the patient's mother, the patient had seizures
for + 2 minutes with the form of a whole body spasm. the patient's entire
body is stiff after that, the patient's body is weak, the patient's eyes glare
upward. After the seizure the patient immediately cries. After 1 hour the
patient had a seizure with a duration of + 3 minutes with the same form of
seizure as before. A few hours before the seizure the patient had high
fever, which is sudden.

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  General  Vital Sign  Anthropometry
Examination

 Heart rate: 115 x/min  Weight 8 kg

 General appearance : Mild sick
 Consciousness : Compos mentis
 Respiratory rate : 32 x/min  Height 74 cm
 Temperature : 37,6oC  Nutritional status
 Oxygen saturation : 99%  Weight for age normal
 Height for age normal
 Weight for Height underweight

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  Head
 Head : Normocephal (+)
 Eyes : clean, symmetrical,
anemis (-/-)
 Nose : good shape, no nasal
flaring, secret (+/+)
 Mouth: good shape, no
cyanotic, clean
tongue, dry mucosal
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 Abdomen  Chest
 Inspection : Symmetrical chest,  Inspection : Looks flat, Supple, there
retraction intercosta (+/+) is no mass, treatable umbilical cord
 Palpation : Symmetrical vocal  Auscultation : Normal bowel sounds
fremitus Percussion : Tympani
 Percussion : Sonor right=left  Palpation : Liver and spleen are not
 Auscultation : Vesicular breath  palpable, skin turgor snaps
sound, ronchi (-/-), wheezing rapidly back
(-/-),
 Regular heart sound, no murmur,
no gallop
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  Meningeal  Physiological  Pathological
Signs Reflex Reflex

 Neck Rigidity :-
 Brudzinski 1 :-
+2/+2 -/-
 Brudzinski 2 :-
+2/+2 -/-
 Kernig :-
 Laseque :-
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 May, 3rd 2018 (11.22)

 Leukocytes : 10.000 /mm3 (Normal : 4.000-30.000 /mm3 )

 Hemoglobin : 10,4 g/dl (Normal : 12,5-16,1 g/dl)
 Hematocrit : 31,.6 % (Normal : 33-42%)
 Trombocytes 3
: 234.000/mm (Normal : 150.000-400.000/mm ) 3

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 Differential Diagnosis
 Complex febrile seizure ec  Working Diagnosis
Dengue Fever
 Complex febrile seizure ec  Complex febrile seizure ec Dengue Fever
Dengue Hemorrhagic Fever
 Complex febrile seizure ec
Thyphoid Fever

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 IVFD 30 tpm mikro
 Injeksi Paracetamol 80 mg/ 6 jam iv (k/p demam)
 PO Dizapem 3x1 mg pulv
 Cek elektrolit

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 S O A P
 IVFD NaCl 25 cc/ jam
 Ij. Paracetamol 100 mg/ 6 jam
 Seizure (+) • General appearance :
 Complex febrile seizure ec PO Diazepam 3x1 mg pulv
• HR : 179 bpm
 Fever (+) • RR : 30 bpm Dengue Fever dd DHF dd  Ij. Antrain 100 mg jika T>39,5C
• T : 41,7 oC Thypoid fever  Ij. Sibital 160 mg loading dose
 Cought (-) • Eyes : Anemis (-/-) M : 3x20 mg iv
• Nose: Secret (+ / +)
 Cold (-) • Thorax: Symmetrical (+), intercostal
 Ij. Ampicilin 4x400 mg iv
 Ij. Dexamethason 3x0,3 cc
 Nausea (-) retraction (-)
• Anterior pulmo: Vesicular (+ / +) SND,  P.O Asam Valproat 2x1,6 cc
 Vomit (-) rhonkii (- / -), Wheezing (- / -)
• Posterior pulmo: Vesicular (+ / +) SND,
 Observation
rhonkii (- / -), Wheezing (- / -)
 Cek GDS
 Ij. Diazepam 2,5 mg + NS 3 cc
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 a. K+ : 4,0 mmol/L (Normal : 3,5-5,3 mmol/L)
 b. Na + : 139 mmol/L (Normal : 135-148 mmol/L)
 c. Cl- : 107 mmol/L (Normal : 97-108 mmol/L)
 GDS : 118 mg/dl (Normal : <180 mg/dl )

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 S O A P
 IVFD NaCl 25 cc/ jam
 Seizure (-) • General appearance :
 Complex febrile seizure ec Ij. Paracetamol 100 mg/ 6 jam
• HR : 110 bpm
 Fever (+) • RR : 28 bpm Dengue Fever dd DHF dd  PO Diazepam 3x1 mg pulv
• T : 37,8oC Thypoid fever  Ij. Antrain 100 mg jika T>39,5C
 Cought (-) • Eyes : Anemis (-/-)  Ij. Sibital 160 mg loading dose
• Nose: Secret (+ / +)
 Cold (-) • Thorax: Symmetrical (+), intercostal
M : 3x20 mg iv
 Ij. Ampicilin 4x400 mg iv
 Nausea (-) retraction (-)
• Anterior pulmo: Vesicular (+ / +) SND,  P.O Asam Valproat 2x1,6 cc
 Vomit (-) rhonkii (- / -), Wheezing (- / -)
• Posterior pulmo: Vesicular (+ / +) SND,
 Ij. Diazepam 2,5 mg + NS 3 cc
rhonkii (- / -), Wheezing (- / -)
bolus pelan prn
 Blood examination tomorrow
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 S O A P
 Seizure (-) • General appearance :
 Complex febrile seizure ec IVFD NaCl 25 cc/ jam
• HR : 120 bpm
 Fever (+) • RR : 32 bpm Dengue Fever dd DHF dd  Ij. Paracetamol 100 mg/ 6 jam
• T : 37,7oC Thypoid fever  PO Diazepam 3x1 mg pulv
 Cought (-) • Eyes : Anemis (-/-)  Ij. Antrain 100 mg jika T>39,5C
• Nose: Secret (+ / +)
 Cold (-) • Thorax: Symmetrical (+), intercostal
 Ij. Sibital 3x20 mg iv
 Ij. Ampicilin 4x400 mg iv H3
 Nausea (-) retraction (-)
• Anterior pulmo: Vesicular (+ / +) SND,  P.O Asam Valproat 2x1,6 cc
 Vomit (-) rhonkii (- / -), Wheezing (- / -)
• Posterior pulmo: Vesicular (+ / +) SND,
 Ij Ceftriaxon 2x300 mg iv
rhonkii (- / -), Wheezing (- / -)
 Trombopop salep 1x2 ue

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 May, 3rd 2018 (11.22)

(28/03/2019) (06:52)
 Leukocytes : 10.000- 10.500 /mm3
 Hemoglobin : 10,4 – 10,5 g/dl
 Hematocrit : 31,6 – 31,9%
 Trombocytes : 234.000 – 207.000 /mm3

 Salmonella Typhi H: 1/100

 Salmonella Typhi O: (-)

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 S O A P
 Seizure (-) • General appearance :  IVFD NaCl 25 cc/ jam
 Complex febrile seizure ec
• HR : 110 bpm  Ij. Paracetamol 100 mg/ 6 jam
 Fever (-) • RR : 230bpm Dengue Fever dd DHF dd  PO Diazepam 3x1 mg pulv
• T : 36,6oC Thypoid fever
 Cought (-) • Eyes : Anemis (-/-)
 Ij. Antrain 100 mg jika T>39,5C
• Nose: Secret (+ / +)  Ij. Sibital 3x20 mg iv
 Cold (-) • Thorax: Symmetrical (+), intercostal  Ij. Ampicilin 4x400 mg iv H4
 Nausea (-) retraction (-)
• Anterior pulmo: Vesicular (+ / +) SND,
 P.O Asam Valproat 2x1,6 cc
 Ij Ceftriaxon 2x300 mg iv H2
 Vomit (-) rhonkii (- / -), Wheezing (- / -)
• Posterior pulmo: Vesicular (+ / +) SND,  Trombopop salep 1x2 ue
rhonkii (- / -), Wheezing (- / -)  Blood examination tomorrow
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 S O A P
 Seizure (-) • General appearance :  IVFD NaCl 25 cc/ jam
 Complex febrile seizure ec
• HR : 128 bpm  Ij. Paracetamol 100 mg/ 6 jam
 Fever (-) • RR : 27 bpm Dengue Fever dd DHF dd  PO Diazepam 3x1 mg pulv
• T : 36,6oC Thypoid fever
 Cought (-) • Eyes : Anemis (-/-)
 Ij. Antrain 100 mg jika T>39,5C
• Nose: Secret (+ / +)  Ij. Sibital 3x20 mg iv
 Cold (-) • Thorax: Symmetrical (+), intercostal  Ij. Ampicilin 4x400 mg iv H5
 Nausea (-) retraction (-)
• Anterior pulmo: Vesicular (+ / +) SND,
 P.O Asam Valproat 2x1,6 cc
 Ij Ceftriaxon 2x300 mg iv H3
 Vomit (-) rhonkii (- / -), Wheezing (- / -)
• Posterior pulmo: Vesicular (+ / +) SND,  Trombopop salep 1x2 ue
rhonkii (- / -), Wheezing (- / -)  Blood examination tomorrow
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 May, 3rd 2018 (11.22)

(30/03/2019) (06:08) (18;57)

 Leukocytes : 10.000- 10.500 – 4500 - 6400 /mm3

 Hemoglobin : 10,4 – 10,5- 10,8 – 10,5 g/dl

 Hematocrit 31,6 – 31,9 – 34,2 – 33,1 %
 Trombocytes : 234.000 – 207.000- 141.000 – 134.000 /mm3

 Salmonella Typhi H: 1/100 – 1/100

 Salmonella Typhi O: (-) – 1/100

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 S O A P
 Seizure (-) • General appearance :  IVFD NaCl 25 cc/ jam
 Complex febrile seizure ec
• HR : 125 bpm  Ij. Paracetamol 100 mg/ 6 jam
 Fever (-) • RR : 32 bpm Dengue Fever dd DHF dd  PO Diazepam 3x1 mg pulv
• T : 37,0oC Thypoid fever
 Cought (-) • Eyes : Anemis (-/-)
 Ij. Antrain 100 mg jika T>39,5C
• Nose: Secret (+ / +)  Ij. Sibital 3x20 mg iv
 Cold (-) • Thorax: Symmetrical (+), intercostal  P.O Asam Valproat 2x1,6 cc
 Nausea (-) retraction (-)
• Anterior pulmo: Vesicular (+ / +) SND,
 Ij Ceftriaxon 2x300 mg iv H2
 Trombopop salep 1x2 ue
 Vomit (-) rhonkii (- / -), Wheezing (- / -)
• Posterior pulmo: Vesicular (+ / +) SND,  Ij Vicilin Sx 3x400 mg iv H1
rhonkii (- / -), Wheezing (- / -)  Blood examination tomorrow
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 May, 3rd 2018 (11.22)

(31/03/2019) (07:15)
 Leukocytes : 10.000- 10.500 – 4500 – 6400 - 4800 /mm3
 Hemoglobin : 10,4 – 10,5- 10,8 – 10,5 – 10,1 g/dl
 Hematocrit : 31,6 – 31,9 – 34,2 – 33,1- 31,8 %
 Trombocytes : 234.000 – 207.000- 141.000 – 134.000 – 116.000/mm3

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 S O A P
 Seizure (-) • General appearance :
 Complex febrile seizure ec
• HR : 125 bpm  Aff infus
 Fever (-) • RR : 31 bpm Dengue Fever dd DHF dd  PO Diazepam 3x1 mg pulv
• T : 36,5oC Thypoid fever
 Cought (-) • Eyes : Anemis (-/-)
 P.O Asam Valproat 2x1,6 cc
• Nose: Secret (+ / +)  Trombopop salep 1x2 ue
 Cold (-) • Thorax: Symmetrical (+), intercostal  PO Azitromicin syr 2x1/2 cth
 Nausea (-) retraction (-)
• Anterior pulmo: Vesicular (+ / +) SND,
 PO Psidii syr 3x1 cth
 PO Paracetamol syr 3x1 cth
 Vomit (-) rhonkii (- / -), Wheezing (- / -)
• Posterior pulmo: Vesicular (+ / +) SND,  Blood examination tomorrow
rhonkii (- / -), Wheezing (- / -)

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 May, 3rd 2018 (11.22)

(01/04/2019) (07:27)
 Leukocytes : 10.000- 10.500 – 4500 – 6400 – 4800 – 5500 /mm3

 Hemoglobin : 10,4 – 10,5- 10,8 – 10,5 – 10,1 – 10,1 g/dl

 Hematocrit : 31,6 – 31,9 – 34,2 – 33,1- 31,8 – 32,0 %
 Trombocytes : 234.000 – 207.000- 141.000 – 134.000 – 116.000 –
116.000/mm 3

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 S O A P
 Seizure (-) • General appearance :
 Complex febrile seizure ec
• HR : 125 bpm  BLPL
 Fever (-) • RR : 31 bpm Dengue Fever dd DHF dd  PO Diazepam 3x1 mg pulv
• T : 36,5oC Thypoid fever
 Cought (-) • Eyes : Anemis (-/-)
 P.O Asam Valproat 2x1,6 cc
• Nose: Secret (+ / +)  Trombopop salep 1x2 ue
 Cold (-) • Thorax: Symmetrical (+), intercostal  PO Azitromicin syr 2x1/2 cth
 Nausea (-) retraction (-)
• Anterior pulmo: Vesicular (+ / +) SND,
 PO Psidii syr 3x1 cth
 PO Paracetamol syr 3x1 cth
 Vomit (-) rhonkii (- / -), Wheezing (- / -)
• Posterior pulmo: Vesicular (+ / +) SND,  PO Cetrizin syr 1x0,25 cc drops
rhonkii (- / -), Wheezing (- / -)

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 May, 3rd 2018 (11.22)

(01/04/2019) (07:27)
 Leukocytes : 10.000 - 10.500 – 4500 – 6400 – 4800 – 5500 - 6000
/mm3
 Hemoglobin : 10,4 – 10,5- 10,8 – 10,5 – 10,1 – 10,1 – 10,8 g/dl
 Hematocrit : 31,6 – 31,9 – 34,2 – 33,1- 31,8 – 32,0 – 32, 6%
 Trombocytes : 234.000 – 207.000- 141.000 – 134.000 – 116.000 –
116.000 – 125.000/mm3

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 Prognosis


Ad Vitam : Dubia ad Bonam
Ad Functionam : Dubia ad Bonam
 Final Diagnosis
 Ad Sanactionam : Dubia ad Bonam
 Complex febrile seizure ec Dengue Fever

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 Febrile seizure (FS) is the most common type of childhood seizure disorder, which
occurs in an age-specific manner, is associated with a fever of 38.0℃ or higher,
and presents without evidence of any definite causative diseases, such as central
nervous system (CNS) infection or metabolic abnormality
 FS are classified into simple and complex

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 Treatments and prophylaxis
 Immediate management (Acute medications such as rectal diazepam (0.5
mg/kg) or buccal (0.4–0.5 mg/kg) or intranasal (0.2 mg/kg) midazolam )
 Continuous anticonvulsant therapy
 In most studies, phenobarbital and valproate have been proven
effective in preventing recurrent FSs7

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