CASE DISCUSSION

PAUL HARIJANTO
 Case 1. DIAGNOSIS ??

• Male 26 years old, referred by peripheral hospital(PH)

with fever for 3 days and diagnosed as DHF grade 1,
because his condition getting worse, developed loss of
concious, he had been referred to district hosp. In PH,
platelets was 42.000, 18.000. Ht 43.3% then 30.3%.
Ig.G positif, IgM negatif
• Examination in DH : afebrile, pale, GCS : E4M1V2, no
Hepatosplenomegaly, no neurological defisit, Lab : Hb
12 gr%, WBC 14750/ mm3, granulocyte 90% , malaria
falcip +4 (15.000 per 200 leuco), parasite count
1.050.000/uL, thrombocyte 30.000 mg/dL, Random
blood sugar 26 mg/dL, SGOT 300 IU, SGPT 325 IU.
E.D.S
Expanded
Dengue
Syndrome
• Was treated with artesunate 120 mg on 0 hr, 12 hrs
and 24 hrs, also 40% dextrose 75cc was given
intravenously. Six hours later he developed
breathless, kussmaul breathing was noted, fever
39C, patient was referred to ICU.
• Parasite count 12000/200WBC, bl.glucose 103
mg%, SGOT 597IU, SGPT 259 IU, Bilirubin total
18.05 U/dL, direct bill 13.8 U/dl. WBC
20.370/mm3.

What’s your management ?

• On the second day he developed convulsion, parasite
count 6910/200 wbc, 110 par/ 1000 rbc. 6hours later
the parasite count 4175/ 200 wbc, SGOT 470u/L ,
SGPT 345 u/L. GCS E1/M2/V2, oliguria and
furosemide was given.

• On the third day, bleeding in the sclera, BP 90/60,

Kussmaul, CVP was inserted, the patient go to cardiac
arrest and died.