Meningitis Tb Lapkas ANAK
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Transcript of Meningitis Tb Lapkas ANAK
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Meningitis Tuberculosis occurs when tuberculosis bacteria
(Mycobacterium tuberculosis) invade the membranes and
fluid surrounding the brain and spinal cord.
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The developing world has 1.3 millioncases of TB and 40,000 TB-relateddeaths annually among childrenyounger than 15 years.
In the developing world, 10-20% ofpersons who die of TB are children.
TBM complicates approximately 1 ofevery 300 untreated primary TBinfections.
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seizuresloss of
consciousness
headache tremor
fever (usuallyhigh)
vomiting
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History of recent TB contactHistorytaking
presence of extrameningeal TBPhysical
examination
lumbar puncture and CSFexamination
Tuberkulin testLaboratory
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Rifampicin INH PyrazinamideEthambutol
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The aim of this paper is to report a case of Meningitis
Tuberculosis on 13 years old and 3 months old girl.
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Name : MH
Age : 13 years old and 3 months old
Sex : Female
Date of Admission : May 3rd 2014
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History of illnessThis has been experienced since 1 week ago and became worse since 1
day ago. she was referred from Sidempuan Hospital by pediatrician withthe main complaint was seizure.
History of seizure was found once when she was in the SidempuanHospital and the duration was 5 minutes. When the seizure comes, thewhole body rigid, the eyes wide opened. When the seizure finished, thepatient lost her conciousness. History of seizure before was not found.
History of fever was found since 1 week ago. The fever was high about380C and didnt getting better with antipyretic. History of headche (+)
since 1 month ago, history of vomiting (+) since 2 weeks ago frequency10x/days the volume cup aqua every vomiting, the content of what is inthe eating and drinking. Cough (+) since 3 weeks ago. History of contact
with an infected person coughed (+). History of weight loss since 3 monthago, however, decreased appetite encountered. Defecation and urine (+)
normal.
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History ofmedications
Inj. Penicillin,Ranitidin,
Ondancentron,Paracetamol.
History ofLabor
he was laboredterm with
4500 gramsand 52
centimeterswhich helpedby doctor in
hospital
History ofImmunization
patients evergiven
immunizationtwice, but it is
not clearwhich type ofimmunization
given
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Present status
Sensorium : GCS 10 (E3 V2 M5)
Temperature : 38,0oC
Weight : 22 kg
Height : 110 cm
Dyspnea, cyanosis, icteric, anemic are not found.
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Head :
Eyes : Light reflexes are found. Pupils are
isochoric. Pale conjungtiva palpebra inferior is not
found on both eyes. Ear and mouth appearancesare normal. Naso gastric tube is found on nose.
Neck : Enlargement of lymph node is not found.
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Thorax : Symmetrical fusiform. Heart rate is 100
beats per minute, regular and no murmur.
Respiratory rate is 20 breaths per minute, regular,
and no rales.
Abdomen : Soepel. Peristaltic is found normal.
Liver and spleen are not palpable.
Extremities : Pulse 100 times per minute, regular.
Tone per volume was adequate. Warm. CapillaryRefill Time not more than 3 minutes.
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Unit Control Result
Hematology
Hemoglobin g% 12,0 - 14,4 11,00
Hematocrit % 35 - 42 27,40
Leukocyte 103/mm3 4,511,0 14,7
Thrombocyte 103/mm3 150450 292
Arterial Blood Gas Analysis
pH 7,35 - 7,45 7,457
pCO2 mmHg 38 - 42 35,2
pO2 mmHg 85 - 100 166,7
Bicarbonate mmol/L 22 - 26 26,4
Total CO2 mmol/L 19 - 25 27,6
BE mmol/L (-2)(+2) 2,4
O2Saturation % 95 - 100 99,4
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Electrolyte
Natrium mEq/L 135-155 130
Kalium mEq/L 3,6-5,5 4,1
Chloride mEq/L 96-106 96
Renal Test
Ureum mg/dL < 50 35.00
Creatinine mg/dL 0,57 - 0,87 0,87
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Radiography Findings :
Seem small nodular infiltrates in both lungfields
Working Diagnosis :
Meningitis + Suspect TB
Planning :
Mantoux test
Gastric Lavage
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S : Loss of Consciousness (+)O : kepala : mata rc +/+, pupil isokor, conj. Palp. Inf. Pucat (-), T : dbn, N : nasal
canul & NGT, E : dbn
Leher : Pembesaran KBG (-)
Thorax : SF, retraksi (-), HR = 100x/i reg desah (-), Sela iga terlihat jelas, RR
= 20x/I
Abdomen : Soepel, peristaltik (+) N
A : Meningitis TB + Poor Nutrition
P : IVFD NaCl 0,9% 21 gtt/i mikro
-IVFD NaCl 3% 5cc/KgBW/12 hrs
-Inj. Phenytoin 20 mg/KgBW/IVFD
-Inj. Ceftriaxone 1 gr/12 hrs/IVFD
-Inj. Ampicillin 1 gr/6 hrs/IVFD
- PCT 3 x 250 mg
Diet SV 100 cc/ 3 hrs with 1540 kkal + 45 gr protein
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S : Loss of Consciousness (+)
O : kepala : mata rc +/+, pupil isokor, conj. Palp. Inf. Pucat (-), T : dbn, N : nasal canul & NGT, E : dbn
Leher : Pembesaran KBG (-)
Thorax : SF, retraksi (-), HR = 100x/i reg desah (-), Sela iga terlihat jelas, RR = 20x/I
Abdomen : Soepel, peristaltik (+) N
A : Meningitis TB + Poor Nutrition
P : - IVFD NaCl 0,9% 41 gtt/i mikro -IVFD NaCl 3% 110cc/KgBW/12 hrs
-Inj. Phenytoin 55 mg/KgBW/IVFD
-Inj. Ceftriaxone 1 gr/12 hrs/IVFD
-Inj. Ampicillin 1 gr/6 hrs/IVFD
-PCT 3 x -Etambutol 1 x 350 mg Multivitamin with FE 1x cth I
Inj.Phenitoin 65mg/12 jam in nacl 0,9% 20ccx/20 minute
250 mg
Diet SV 100 cc/ 3 hrs with 1540 kkal + 45 gr protein
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S : Loss of Consciousness (+)
O : kepala : mata rc +/+, pupil isokor, conj. Palp. Inf. Pucat (-), T : dbn, N : nasal canul & NGT,E : dbn
Leher : Pembesaran KBG (-)
Thorax : SF, retraksi (-), HR = 100x/i reg desah (-), Sela iga terlihat jelas, RR = 27x/i
Abdomen : Soepel, peristaltik (+) N
A : Meningitis TB + Poor Nutrition
P : Meningitis TB + Poor Nutrition
- IVFD NaCl 0,9% 41 gtt/i mikro
-IVFD NaCl 3% 110cc/KgBW/12 hrs
-Inj. Phenytoin 55 mg/KgBW/IVFD
-Inj. Ceftriaxone 1 gr/12 hrs/IVFD
-Inj. Ampicillin 1 gr/6 hrs/IVFD
Diet SV 100 cc/ 3 hrs with 1540 kkal + 45 gr protein
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The developing world has 1.3 million cases
of TB and 40,000 TB-related deaths annuallyamong children younger than 15 yearsA13 years old and 3 months girl
Its manifestations like seizures, loss ofconsciousness, headache, tremor, fever
usually high, and vomiting.
The main complaint was loss ofconciousness which had beenexperienced since 1 week ago.
History of seizure, fever, headache,
and vomiting was found.
On examination of the tuberculin test wasfound bacteria growth
the results of tuberculin testexamination stated that the absenceof bacterial growth not found in the
blood
The treatment of TB in Children includingRifampicin, INH, Pyrazinamide, andEthambutol.
This patient got RHZE regiments
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