Ospital ng Maynila Medical Center DEPARTMENT OF PEDIATRICS Quirino Avenue corner Roxas Boulevard Malate, Manila
Patient’s Name: Ilaban, John Matthew Address: 2213 Sater St., Sta. Ana, Manila Age/Sex: 17/male Date Admitted: May 21, 2008 Admitting Diagnosis: SVT etiology to be determined Physician–in-charge: Dr. Troncales/Dr. Salloman/Dr. Manalo Clerk-in-charge: Erum/Fernando/Figueras/Fuentes/Cuvin Florentino/Kalalo/Lingao/Liwag/Lopez
Hospital No. 1837935 Room No. 418
PATIENT DISCHARGE SUMMARY This is a case of a 17 year old male who came in due to dizziness. HISTORY OF PRESENT ILLNESS: Present condition started 4 hours PTC when patient felt dizziness described as his surrounding is spinning. It was accompanied with palpitations, diaphoresis, difficulty of breathing and chest pain. There was no loss of consciousness, no blurring of vision, no orthopnea, no paroxysmal nocturnal dyspnea. Hence, consult at OMMC- ER. REVIEW OF SYSTEMS: HEENT: no headache, no fever, no epistaxis Chest and Lungs: no cough, no colds Abdomen: no abdominal pain, no diarrhea, no constipation, no changes in bowel movement Extremities: no muscle or joint pain Endocrine: no polyuria, no polydipsia, no polyphagia PAST MEDICAL HISTORY: (+) previous hospitalization-1998—vehicular accident No allergies FAMILY HISTORY/ PERSONAL AND SOCIAL HISTORY: (-) HPN (-) DM (-) allergy PHYSICAL EXAMINATION: General: conscious, coherent, not in cardiorespiratory distress Vital Signs: BP= 100/80 HR = 75 RR = 20 Temp = 37.5 0C HEENT: anicteric sclera, pink palpebral conjunctiva, no cervical lymphadenopathy Chest/Lungs: symmetric chest expansion, no retractions, clear breath sounds Heart: adynamic precordium, normal rate and regular rhythm,PMI at 5th left ICS midclavicular line, no murmurs Abdomen: flat, normoactive bowel sounds, no tenderness Extremities: grossly normal, full and equal pulses, no cyanosis, no edema ASSESSMENT: SVT etiology to be determined PLAN: For admission
Course in the Wards: On the 1st HD, the patient was on IVF: PNSS 1L at a rate of 20gtts/min, 12 L ECG was done. He was also maintained in a complete bed rest without bathroom privileges. Vital signs monitored every 1 hour. On the 2nd HD, IVF: PNSS 1L to run at 20gtts/min, propranolol 10mg tab and paracetamol 500mg tab were given and 12 L ECG was done. Vital signs monitored every 1 hour. On the 3rd HD, IVF: PNSS 1L to run at 20gtts/min. Vital signs monitored every 4 hours. On the 4th HD, IVF: PNSS 1 L to run at KVO rate was given. Propranolol was given every 12 hours except when SBP< 90 and CR< 60. Cotrimoxazole was also given every 12 hours. Vital signs monitored every 4 hours. On the 5th HD, diet as tolerated. IVF given was PNSS 1L x KVO then shifted to 10gtts/min. Paracetamol 500mg/tab was given q4 or if temperature is> 37.8C. Nitroglycerin patch was placed on the chest. Paracetamol amp TIV was given q4. Cefuroxime 1 gram SIVP q8 ANST was also started. 12-L ECG was done. On the 6th HD, IVF was revised to D5LR 1L to run at 27gtts/min (FM). Blood and urine C/S was done. CBC/PC was repeated. Cotrimoxazole was discontinued. VSq1. On the 7th hospital day, diet was as tolerated. IVF was maintained. Patient was given O2 support as needed. Urine culture was done. Vital signs were monitored every hour.
SUMMARY OF LABORATORY RESULTS CBC with PC (5-25-08) Normal Values May 21 WBC 8.0-38.0 X 109/L 7.7 RBC 4.6-6.6 X 1012/L 5.66 HGB 150-220 g/L 12.9 HCT 40 – 54 % 39.4 PLATELET 150-400 X 109/L 284 NEUTROP 0.23-0.77 66.5 LYMPHO 0.25-0.36 25.9 MONO 0.02-0.09 6.2 EOSINO 0.00-0.04 0.8 CLINICAL CHEMISTRY CALCIUM MAGNESIUM SODIUM POTASSIUM CHLORIDE CREATININE KINASE MB URINALYSIS COLOR TRANSPARENCY EPITHELIAL CELLS MUCUS THREAD AMORPHOUS URATES PUS CELLS ERYTHROCYTES CAST 5/24 Yellow Slightly turbid Few Many Few 7-11/hpf 0-2/hpf 5/21 2.14 0.75 148 4.0 109
May 26 11.2 5.95 12.9 41.1 165 85.2 8.3 6.4 0.1
May 27 5.4 3.74 8.6 26.1 183 89.9 6.7 3.0 0.0
5/27 Dark yellow Slightly turbid Few Moderate Moderate 25-30/hpf 10-15/hpf Pus cast: 5-7/lpf Fine granular cast: 2-4
DRUG INDEX Propranolol Antagonizes catecholamines at both β1 and β 2 adrenoceptors Hypertension, angina of effort, cardiac arrhythmias, hypertrophic subaortic stenosis, migraine prophylaxis Hypertension: 160-480 mg in divided doses Heart failure, bradycardia, heart block of any degree, bronchospasm, metabolic acidosis, diabetic ketoacidosis and after prolonged fasting MAOI’s, phenothiazines, sympathomimetic agents, antimuscarinic agents, diuretics, anti-arrhythmic drugs, Ca antagonists, digitalis, neuromuscular blockers, levodopa, cimetidine Effects reduced by PABA and procaine type local anesthetics and enhanced by highly bound drugs. May potentiate effects of methotrexate, warfarin, sulfonylureas. Bradycardia, CHF, conduction disorders; sleep and visual disturbances; GI disturbances, bronchospasm, hematologic reactions, rarely alopecia, paresthesia, rashes and dry eyes Tab 10 mg, 20 mg, 40 mg
Treatment of infections of the upper and lower respiratory tract, kidney and GUT, skin and soft tissues. Other infections caused by sensitive organisms Infections of the respiratory
Adult: 120mg/kg body wt daily in 2-4 divided doses. Children 6-12 yrs old: 480mg; 6months – 5 yrs: 240mg; 6 wks – 5 months: 120mg. To be given 12 hourly Adult: 750mg IM or IV Children: 30-
Hypersensitivity to sulfonamides; marked liver parenchymal damage; blood dyscrasias or severe renal insufficiency; pregnancy, lactation.
GI disturbances, Steven-Johnson and Lyell’s syndrome. Rarely, hepatitis, blood disorders, pseudomembranous colitis.
SMZ 400mg, TM 80mg Capsule SMZ 400mg, TM 80mg Tablet SMZ 200mg, TM 40mg per 5 mL suspension 250mg vial 750mg vial
Hypersensitivity to cephalosporins
Concomitant therapy with aminoglycosides
Hypersensitivity reactions, GI disturbances,
A weak prostaglandin inhibitor in peripheral tissues with no significant antiinflammatory effects.
tract, ENT, soft tissues and bones. Also for O and G infections, wound infections, erysipelas and peritonitis. Pyrexia of unknown origin. Fever and pain with common childhood disorders, tonsillitis, upper respiratory tract infections, postimmunizaton reactions, after tonsillectomy and other conditions. Prevention of febrile convulsions, headache, cold, sinusitis, musclepain, arthritis and toothache.
100mg/kg/day in 3-4 divided doses.
may cause renal impairment.
transient pain at IM injection site
Adult and children > 10 yrs: 2-3mL; <10 yrs: 1-2 mL. Depending on the severity of the case, dose may be repeated 4 hourly. In sever cases, dose may be administered via IV very slowly.
Renal and hepatic failure
Hemtological, skin and other allergic reactions
150mg/mL x 2mL amp