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Instructions

Divide the class into 4 groups. Each group will be given a case and its corresponding
questions to answer. Each group should prepare to present the answers on November
7, Friday 8 am by powerpoint presentation. This is a group work but anybody from
the group could be called to present and explain the answer.
References:
Dengue Clinical Case Management Guidelines 2011 by the Department of Health
Revised Dengue Guidelines 2012 by the Philippine Pediatric Society
Dengue Guidelines for Diagnosis, Prevention and Control by the World Health
Organization 2009
Group 1
1. A 5 y/o child from Quezon City came to your clinic due to moderate to high grade
fever associated with headache for the past 3 days. There were no cough and colds,
no diarrhea, no abdominal pain. She is able to play, eat and drink. On PE, she is
febrile 38 C, BP 100/ 60 RR: 24 CR: 105 weight : 20 kg, flushed skin, full pulses
The rest of the PE was unremarkable.
What else in the history will you ask?
What is your impression?
What are your differential diagnoses?
What will you do as the doctor of this patient?
Will you request for laboratory tests? If yes, what laboratory tests will you request?
If you are suspecting Dengue, what Dengue test/ s will you request?
Will you send home the patient?
If you send home the patient, what will you advise the parent?
When will you decide to admit/ hospitalize the patient?
Group 2
2. The above 5y/o child with 3 day history of moderate to high grade fever was sent
home. For the next 2 days, she was still febrile now associated with several episodes
of vomiting and abdominal pain. She would now refuse any food or drink.
Vital signs: temp : 37 C RR: 20 CR 95 BP: 90/60 wt: 20 kg, petechiae on the
palate, full pulses. Other PE was unremarkable.
What is your impression?
What will you do when you see this patient?
What laboratory tests will you request?
If you are highly suspecting dengue, what dengue test will you request?
You decided to admit the patient, what intravenous fluid ( IVF) will you start? How
much will you run the IVF?
What will you monitor on the patient?
When is the critical phase of this patient? What are the potential problems during this
phase?
Group 3

3. A 1 y/o child has been having high fever for the past 5 days. Today is the 6th day
of illness and he is currently afebrile. His mother noted him to be weak looking hence
was brought to the emergency room. She has a sister who recently had dengue.
Temp 36 C BP 80/60. RR 40 CR 140 Wt: 10 kg
Awake, weak looking, capillary refill time 3 sec, cool extremities, poor pulses
If you are suspecting dengue, how will you classify the Dengue of this patient?
How will you manage this patient?
What fluids will you use for this patient? How will you run it?
If your patient improves with your initial fluid, what will you do next? How will you
monitor this patient
If the child did not improve with your initial fluids, how will you manage the patient?
What fluids will you give? What and/ How will you monitor this patient?
When will you give crystalloids? When will you give colloids?
When will you give blood transfusion to this patient?
If you would like to confirm if this is dengue, what specific Dengue test would you
request?
Group 4
4.The above patient ( 1 y/o with severe dengue) was able to overcome bleeding and is
now stable. He has been afebrile for the past 2 days. He is still has an intravenous
fluid running at 50cc/ hr. You noted the patient to have decreased breath sounds on
auscultation of the right lung. RR: 30 Wt: 10.5 kg
What is now your impression on the patient?
At what phase of Dengue does the patient belong? What are the potential problems
during this phase?
What labs/ imaging will you request?
How will you manage the patient?
When will you send home the patient?
Can the patient still have dengue?
How will you counsel the family regarding Dengue?