choice

Summary – Baby D.Sowjanya
Donated Rs 50,000/-Case

FINAL DIAGNOSIS;
1.SEVERE DENGUE HEMORRHAGIC SHOCK
2.ARDS WITH PULMONARY EDEMA
3.LIVER DYSFUNCTION WITH COAGULOPATHY
4.SEPSIS

Issues & Course of the Illness:

  1. Respiratory System – ARDS / VENTILATION: Baby Sowjanya presented to the Emergency Room in a hypoxic &irritable state with severe pulmonary edema, Pulmonary Hemorrhage, Respiratory Failure and Circulatory SHOCK. She was immediately fluid resuscitated, intubated and shifted to the PICU for further ventilatory & intensive care management.

    She needed extremely high pressures to maintain oxygen saturations on the conventional ventilator. She was also noted to have significant bouts of pulmonary hemorrhage needing High Frequency Oscillatory Ventilation (HFOV) to sustain life. She gradually settled on HFOV with high pressures & 100% FiO2.

    Chest X-ray & arterial blood gases suggested pleural effusion, pulmonary edema and Severe ARDS

    Over the next 5 days she has hemo-dynamically stabilized, pulmonary hemorrhage has subsided & was shifted to conventional ventilation and subsequently extubated to Non Invasive Ventilation.

  2. Cardio Vascular System: Baby Sowjanya was admitted with significant circulatory failure & Severe SHOCK needing multiple fluid boluses & 

    inotropes to maintain blood pressure & peripheral perfusion. Despite repeated crystalloid & colloid infusion and blood products she needed up to 4 inotropes to maintain her hemo-dynamic stability. Gradually she improved with intensive care management and her cardiac support could be successfully weaned.

  3. HEPATIC DYSFUNCTION & Severe COAGULOPATHY: Liver Enzymes were grossly elevated & Coagulation Profile was significantly deranged.

    In view of recurrent pulmonary hemorrhage & deranged coagulation profile, Vitamin K, Fresh Frozen Plasma, Cryo-precipitate & Single Donor Platelets were given repeatedly as per the need.

    Child also needed I unit of Packed Red Cells as the Hemoglobin percentage dropped to 7.5 gm%.

    Liver enzymes, bilirubin & coagulation parameters have gradually improved clinically and no further bleeding was noticed.

  4. SEPIS: Sowjanya was also noted to have a high CRP & concurrent SEPSIS, which gradually responded to IV antibiotics & intensive care management.


    Sowjanya has gradually recovered from all the above systemic difficulties and was successfully discharged home without any residual deficits.