Discharge Summary / Clinical Abstract: Sept 12-15, 2011

Here are some of the details of the  clinical abstract of Lucas' last confinement:

Date of Admission: 12-SEP-2011
Date of Discharge: 15-SEP-2011

Attending Physician: Agnes Alarilla-Alba

Referral Doctor/s:
Ma. Neva Luna Cutanda Batayola-Ranollo
Dexter Eugene Dyogi Cheng

Reason for Admission: Vomiting

Significant Physical and Other Findings
Temp: 38.7 HR 128 RR 28 BP 90/60; Slightly sunken eyeballs, clear breath sounds, low set ears, widely spaced eyes, regular cardiac rhythm, (+) GR3/6 murmur, soft abdomen, hyperactive bowel sounds, full pulses

Diagnosis: Final
Severe myocarditis with myocardial dysfuntion secondary to severe dengue shock syndrome; pneumonia severe with severe pulmonary artery hypertension; hypovolemia severe secondary to acute gastroenteritis and severe dehydration

Significant Diagnoses/Co-morbidities (secondary diagnoses)
Trisomy 21; Hirschsprung's disease

Procedures performed
Blood Examinations: CBCPC, Sodium, Potassium, Blood Culture, Magnesium chloride
Urine Test: Urinalysis
IVF: Plain LR, Plain NSS
Medications: Paracetamol, Zinc, Erceflora, Ceftriaxone, Salbutamol, Epinephrine, Dopamine, Dobutamine

Course in the ward:
Upon admission, patient was hooked to IV fluids. Laboratory exams were done. Patient was initially started on mild hydration. On the first hospital day, patient had episodes of loose stools. Patient's skin was noted to be mottled, and had signs of dehydration. IV fluids were infused. Despite fluid resuscitation, patient had persistent signs of dehydration. Ceftriaxone was started. Referral to pediatric intensive care was done and patient was subsequently transferred to pediatric ICU for closer monitoring.

On the first PICU day, patient was noted to have coughing episodes and tachypnea. Chest x-ray were done. Salinase drops were started, and secretions were suctioned as needed.

On the second PICU day, patient had decreased amount and frequency of stools. Repeat CBC was suggestive of Dengue Fever. Patient was tachycardic, with flushed skin, with harsh breath sounds, bibasal rales, full pulses, and wrm extremities. Patient was diagnosed to have dengue fever with warning signs. Pneumonia and compensated shock secondary to severe dehydration secondary to acute gastroenteritis.

On third PICU day, patient was noted to have increasing tachypnea with desaturations. Patient was intubated and started on dopamine drip. ABG was done, Vitamin K was given. Agressive fever control was done. Chest x-ray showed progression of bilateral pneumonia with confluent densities at the right upper and middle lobes.

At 6:20am, patient was hypotensive and persistently febrile and tachycardic. He had no urine output and pulses were weak.
At 6:50am, patient went into asystole. CPR was started, epinephrine was administered every 3 minutes, as well as sodium bicarbonate. At 7:10am, sinus rhythm was regained. Dopamine, dobutamine and epinephrine drips were maintained.
At 7:30am, patient again went into asystole. CPR was done but there was no response after 40 minutes.
Patient was pronounced dead at 8:10am.