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Dengue Hemorrhagic Fever III

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Identifying data:
? D.A is a 6 year old Filipino male, Roman
Catholic born on September 2, 2003 from
Caloocan City admitted for the first time
on July 25, 2010
iource and Reliability
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Physical examination
? ´eneral survey: awake,afebrile, coherent, not in
cardiorespiratory distress
? Vital signs: pP: 80/50 mmHg, ëR: 118 bpm, RR: 30,
T: 36.6 ë
? nthropometrics: Wt: 17 kgs. Ht: 103 cm
? HEE·T: nictric sclerae, pink palpebral sclerae, no
tonsillopharyngeal congestion, no
cervicolymphadenopathies
? Thorax and Lungs: Equal chest expansion,
decreased breath sounds at the lower lung fields
? ëVi: adynamic precordium, normal rate and rhythm,
no murmurs
? bdomen: flat, soft, tenderness on the epigastric
area and right flank, · pi
? Extremities: poor pulses, ëRT > 4 secs, cold
extremities
? Rectal exam: no skin tags, no fissure, with good
sphincter tone, empty rectal vault with yellowish
material upon withdrawal of the examining  
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DHF vs. DF
Dengue fever Dengue Hemorrhagic fever

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Dengue Hemorrhagic fever
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Prognosis:
? The case-fatality of DHF/Dii is 10% or higher if
untreated.
? With supportive treatment, fewer than 1% of such
cases succumb.
? Recovery is rapid and without sequelae
WHù classification:
? ´rade I - thrombocytopenia + hemoconcentration.
bsence of spontaneous bleeding.
? ´rade II - thrombocytopenia + hemoconcentration.
Presence of spontaneous bleeding.
´rade III - thrombocytopenia + hemoconcentration.
Hemodynamic instability: filiform pulse, narrowing of
the pulse pressure (< 20 mmHg), cold extremities,
mental confusion.
´rade IV - thrombocytopenia + hemoconcentration.
Declared shock, patient pulseless and with arterial
blood pressure = 0 mmHg (dengue shock syndrome
- Dii).
Differentials:
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