Recently, City Children’s Hospital received children NG. DRAW. DRAW.. 13 years old, male, weight 55 kg, overweight (at this age, weight is about 34-40kg), living in Binh Thuan, History: 4 days, N1-N3: child fever 39 degrees Celsius, headache, muscle pain . N4 children with fever, abdominal pain, vomiting, lethargy, cold hands and feet, were admitted to a local hospital with poor pulse condition, difficult to measure blood pressure, Hct 52%, platelets 12000/microL, received anti-shock fluids according to the protocol. , the child’s condition did not improve, his breathing was slow, he vomited blood, he had black stools, so he consulted and transferred to the City Children’s Hospital.
Here, the child also presented with pulse shock 124 l/p, blood pressure 100/80 mmHg, Hct 16%, dyspnea, traction 44 l/min. Diagnosis of severe Dengue hemorrhagic fever N4 re-shock, prolonged shock, respiratory failure, severe gastrointestinal bleeding, overweight/obesity, continued anti-shock fluid therapy under the guidance of CVP, dynamic blood pressure invasive pulse, CPAP ventilatory support followed by intubation for breathing, bladder pressure measurement, blood transfusion, fresh frozen plasma, cryoprecipitate, platelet concentrate.
Hemodynamic status improved but the child continued to pass melena, Hct 18-22% despite transfusion of 2500ml of red blood cells, 900ml of fresh frozen plasma, 20 units of cryoprecipitate, and 12 units of platelet concentrate. . Children were consulted with specialists in gastroenterology, surgery, imaging, anesthesia, hematologic resuscitation, blood banking, emergency upper gastrointestinal endoscopy, and SIDS, mucosal inflammation, hemorrhagic edema, and trunk. Mucosal mucosa hemorrhagic disease, HOSPITAL mucosal hemorrhagic inflammation, GOLDEN DUAL has 01 ulcer of size 7x8mm, bleeding in the stream, treated: gastric lavage with 1% Adrenaline, conduct injection. Blood with adrenaline 1%oo around the duodenal ulcer, then pump adrenaline 1%oo into the bottom of the ulcer. After the test, the ulcer did not bleed more. The child continued to receive respiratory support, mechanical ventilation, omeprazole drug to reduce gastric secretion, no need for additional blood transfusion, Hct 35-37%. Results after nearly a week of treatment, the child’s condition gradually improved, weaned from the ventilator, and was awake. This is a case of severe dengue hemorrhagic fever shock, gastrointestinal bleeding due to duodenal ulcer with no previously recorded etiology, so medical staff as well as parents are very attentive.
It is also worth mentioning that parents actively kill mosquitoes, swarms, sleep under mosquito nets and need to monitor and detect early signs to take their children to medical facilities in time. That is, if you see a child with a high fever for more than 2 days, showing one of the following signs, you need to take the child to the hospital immediately.
- Irritability, irritability, irritability or lethargy
- Stomachache
- Nosebleeds, bloody teeth or vomiting blood, black stools
- Cold hands and feet, lying in one place not playing, giving up sucking, eating and drinking
Doctor of K2 Nguyen Minh Tien
City Children’s Hospital
