case presentation : severe dengue with menstruation and plasma leakage
TRANSCRIPT
![Page 1: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/1.jpg)
Laporan KasusSevere Dengue dengan
Menstruasi dengan Progresif Kebocoran Plasma
PEMBIMBING:Dr.dr. Soroy Lardo, Sp.PD FINASIM
DISUSUN OLEH:Bethari Lekso Aji
KEPANITERAAN KLINIK ILMU PENYAKIT DALAMDIVISI PENYAKIT TROPIK DAN INFEKSI
RSPAD GATOT SOEBROTO JAKARTAFAKULTAS KEDOKTERAN UPN VETERAN JAKARTA
2016
![Page 2: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/2.jpg)
PENDAHULUAN
![Page 3: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/3.jpg)
- Sepanjang Tahun
- >> Musim hujan
- Komplikasi Kematian
DF, DHF, DSS“DHF is not a continuum of
DF”
![Page 4: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/4.jpg)
STATUS PASIEN
![Page 5: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/5.jpg)
Identitas Pasien
Nama : Ny.AB Tanggal Lahir : 30 April 1985 Umur : 31 tahun Status Perkawinan : Menikah Pekerjaan : Ibu Rumah
Tangga Agama : Islam Tanggal masuk : 25 November 2016
![Page 6: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/6.jpg)
Anamnesis
Keluhan Utama :
Demam sejak 3 hari SMRS
![Page 7: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/7.jpg)
AnamnesisRiwayat Penyakit Sekarang (RPS):
Sejak 3 hari SMRS pasien demam, demam terjadi mendadak, demam terus menerus sepanjang hari, demam sempat terukur sampai 40˚C, demam sempat diobati dengan obat penurun panas lalu demam menurun , namun setelah itu demam kembali tinggi, demam disertai mual dan muntah, muntah 3x berisi air tanpa darah, sebanyak ¼ gelas air mineral setiap muntah, BAB cair 3x/hari, banyaknya ½ gelas, air lebih banyak daripada ampas, tanpa lendir dan darah, berwarna kuning kecoklatan dan tidak berbau busuk.
![Page 8: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/8.jpg)
Anamnesis
Riwayat Penyakit Sekarang (RPS):
Selain itu pasien mengeluh sakit kepala, nyeri sendi, nyeri di belakang bola mata, badan lemas, mulut pahit, serta tidak nafsu makan. Pasien menyangkal adanya mimisan, tidak muncul bintik-bintik merah di lengan, badan maupun kaki. BAK normal, warna kuning jernih, tidak nyeri. Tidak ada riwayat transfusi darah. Batuk pilek tidak ada. Pasien tidak melakukan perjalanan ke daerah endemik malaria sebelumnya.
![Page 9: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/9.jpg)
Anamnesis
Ax
RPD
RPK
RPO
RPSOS
![Page 10: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/10.jpg)
Pemeriksaan Fisik
Keadaan umum : Tampak sakit sedang
BB: 47 kg; TB : 145 cm;
IMT : 22,3 (Normoweight) Kesadaran : Compos mentis Tanda vital : TD : 108/60 mmHg
Nadi: 88 x/menit, reguler, kuat angkat
Suhu: 37,2 0C per axilla
RR: 20 x/menit, reguler, tipe torakoabdominal
VAS : 1
![Page 11: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/11.jpg)
Pemeriksaan Fisik
Kepala : Normocephal, Rambut : Hitam, distribusi merata, tidak mudah dicabut
Wajah : Simetris, Deformitas (-) Mata : Konjungtiva anemis (-/-), sklera ikterik (-/-),
pupil bulat isokor 3-4 mm, refleks cahaya langsung dan tidak langsung (+/+)
THT : Rhinorea (-), Otorea (-), Faring tidak hiperemis, tonsil T1-T1 tenang
Mulut : Mukosa kering, coated tongue (-), atrofi papil lidah (-)
![Page 12: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/12.jpg)
Pemeriksaan Fisik
Leher Pembesaran KBG (-) Pembesaran tiroid (-) JVP : 5 ± 0 cm
![Page 13: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/13.jpg)
Pulmo : Inspeksi : Normochest, simetris, pengembangan
dada kanan = kiri, sela iga tidak melebar, retraksi intercostal (-), spider naevi (-)
Palpasi : Pengembangan kedua dinding dada simetris, vokal fremitus kanan dan kiri sama
Perkusi : Sonor di seluruh lapang paru Auskultasi : Suara dasar vesikuler, wheezing (-/-),
ronchi (-/-)
Pemeriksaan Fisik
![Page 14: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/14.jpg)
Jantung : Inspeksi : Tak tampak ictus cordis Palpasi : Iktus cordis teraba, kuat angkat di ICS V
linea midclavicula sinistra, thrill (-) Perkusi :
Batas pinggang jantung ICS III linea sternal sinistra
Batas kiri ICS V linea midclavicula sinistra Batas kanan ICS III linea sternalis dekstra
Auskultasi : BJ I dan II reguler, Murmur (-), Gallop (-)
Pemeriksaan Fisik
![Page 15: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/15.jpg)
Pemeriksaan Fisik
Abdomen :
Inspeksi : Mendatar , scar (-), Caput medusa (-), venektasi (-)
Auskultasi : BU (+) normal
Palpasi : Supel, Nyeri tekan (+) epigastrium , nyeri lepas (-), defans muskular (-), fenomena papan catur (-), tidak ada pembesaran hati maupu limpa, tidak teraba massa, turgor kulit normal, nyeri ketok CVA tidak ada.
Perkusi : Timpani, pekak alih (-) Ekstremitas : Akral hangat, CRT < 2 detik, edema
(-), Tourniquet test (+)
![Page 16: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/16.jpg)
Pemeriksaan PenunjangHasil Pemeriksaan Saat ini Nilai Rujukan
Hb 11.4
33
12.0 -16.0 g/dl
37 – 47 %Ht
Eritrosit 3.9 4.3 – 6 juta/µl
Leukosit 3330 4800-10800/µl
Trombosit 87000 150000 – 400000/µl
MCV 84 80 – 96 fL
MCH 29 27 – 32 pg
MCHC 35 32 – 36 g/dl
RDW 12.60 11.5 – 14.5 %
![Page 17: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/17.jpg)
Pemeriksaan Penunjang
Hasil Pemeriksaan Saat ini Nilai RujukanHitung Jenis Basofil Eosinofil Neutrofil Limfosit Monosit
00
74188
0 – 1 %1 – 3%
50 – 70 %20 – 40%2 – 8 %
Imunoserologi Dengue NS 1 Ag Positif Negatif
![Page 18: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/18.jpg)
Resume Ana
mnesis
Ny.AB 31 tahun datang dengan febris H+3, febris disertai nausea dan vomitus, nyeri epigastrik, diare, cephalgia, nyeri retroorbita, artralgia, malaise dan anoreksia.
Pe
meriksaan Fisik
Keadaan umum sakit sedang, kesadaran compos mentis, suhu 37,2˚C, didapat nyeri tekan di daerah epigastrium, serta rumple leed positif.
Penunjang
Pemeriksaan penunjang didapatkan adanya leukopenia (Leukosit 3330/ul), trombositopenia (Trombosit 87000/ul), dan dengue NS 1 Ag positif.
![Page 19: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/19.jpg)
Daftar Masalah
DHF Grade I H+3
![Page 20: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/20.jpg)
PengkajianAnamnesis :
Demam terus menerus, tinggi dan terjadi mendadak. Artralgia Nyeri retroorbita Nausea vomitus Diare
Pemeriksaan Fisik : NT regio epigastrium, rumple leed(+)
Pemeriksaan Penunjang : Leukosit : 3330 /uL, Trombosit : 87.000 /uL, Dengue NS1 Ag positif
![Page 21: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/21.jpg)
Pengkajian1) Rencana Diagnosis :
- DPL/12 jam
- SGOT/SGPT, ur/cr, albumin besok
Monitoring : Tanda vital/ 8 jam, Urine Output
2) Rencana Terapi
- IVFD Asering 500 cc/6 jam, 30 tpm
- Cernevit dalam NaCl 0,9% 100 cc habis dalam 1 jam
- MDX Propoelix 3 x 2 tab
- Omeprazol 1 x 40 mg IV
- Sistenol 3 x 1 tab
- Ondansentron 2 x 4 mg IV
Diet : Lunak Biasa 1500 kalori/hari
![Page 22: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/22.jpg)
Kasper, et al. 2015. Harrison’s pronciple of internal medcine 19th Ed. USA ; McGrawHill
![Page 23: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/23.jpg)
Derajat DHF
![Page 24: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/24.jpg)
Manifestasi Klinis
WHO. 2011. Comprehensive guidelines for prevention and control of dengue and dengue haemorhagic fever. India
![Page 25: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/25.jpg)
Follow Up
3 3 4 4 5 5 5 6 6 6 7 7 8 8 90
10000
20000
30000
40000
50000
60000
70000
80000
90000
100000
Trombosit
Trombosit
Demam (S:39,8˚C)Menstruasi H-1
Pemanjangan APTT
Antidengue IgM: Negatif Antidengue IgG : Positif
Secondary Infection : Antibody Dependent
Enhancement
![Page 26: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/26.jpg)
![Page 27: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/27.jpg)
Follow Up
3 3 4 4 5 5 5 6 6 6 7 7 8 8 90
5
10
15
20
25
30
35
40
45
Hematokrit
Hematokrit
Demam (-)Muntah persistenBatuk berdahak
USG Abd : AscitesRo THX : Efusi Pleura
![Page 28: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/28.jpg)
Klasifikasi WHO 2009
WHO. 2009. Dengue guidelines for diagnose, reatment,prevention and control. France
![Page 29: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/29.jpg)
WHO. 1997. Comprehensive guidelines for prevention and control of dengue and dengue haemorhagic fever. Geneva
![Page 30: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/30.jpg)
Follow Up
3 3 4 4 5 5 5 6 6 6 7 7 8 8 90
1000
2000
3000
4000
5000
6000
7000
8000
Leukosit
Leukosit
NS1 : Positif
Limfositosisatypical lymphocyte (+)
(lymphocite plasma biru).
![Page 31: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/31.jpg)
![Page 32: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/32.jpg)
![Page 33: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/33.jpg)
Martina, et al. 2009. Dengue virus pathogenesis : an intergrated view. Clin,Microbiol.Rev. 22(4) : 564.
![Page 34: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/34.jpg)
Perjalanan klinis
![Page 35: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/35.jpg)
Penatalaksanaan
Sudoyo, dkk. 2009. Buku ajar ilmu penyakit dalam. Jakarta : Interna Publishing
![Page 36: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/36.jpg)
Sudoyo, dkk. 2009. Buku ajar ilmu penyakit dalam. Jakarta : Interna Publishing
![Page 37: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/37.jpg)
Sudoyo, dkk. 2009. Buku ajar ilmu penyakit dalam. Jakarta : Interna Publishing
![Page 38: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/38.jpg)
Komplikasi
Prolonged shock : asidosis metabolik, pendarahan berat, DIC, disfungsi hepar dan ginjal
Terapi cairan massive : gagal nafas, kongesti paru, kongesti jantung
Terapi cairan terus menerus setelah periode kebocoran plasma : edem pulmonar atau gagal jantung
Abnormalitas metabolik : hipoglikemia, hiponatremia, hipokalsemia
Ensefalopati
WHO. 2009. Dengue guidelines for diagnose, reatment,prevention and control. France
![Page 39: Case Presentation : Severe Dengue With Menstruation and Plasma Leakage](https://reader036.vdocuments.site/reader036/viewer/2022062316/587526a41a28ab3f098b54af/html5/thumbnails/39.jpg)
TERIMAKASIH