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LAPORAN HARIAN BOKS NEUROPEDIATRI

1 Agustus 2015

(Junior : dr. Ading ; Madya : dr.

Renya; Senior : dr. Lidya, dr. Destiana)


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IDENTITAS

DIAGNOSIS

TATA LAKSANA

PEMERIKSAAN LANJUTAN

M. Firza Alfarizi/ Lk/


16-7-09
BB: 14 kg PB: 113 cm
LK: 46 cm
905024
MRS: 30-7-2015

Penurunan
kesadaran ec.
Hipoksia DD/
Meningitis,
Meningoensefalitis,
Ensefalitis +
edema paru

IVFD NaCl 0,9% gtt 12 x makro


Ampisilin 3 x 500mg
Gentamisin 2 x 40 mg
Furosemide 2 x 15 mg
Dexametasone 3 x 4mg
Ceftriaxon 1x1,5gr(3)

31-7-15 LCS :

O2 nasal 1L/menit
D5 NS gtt 8x(makro)/menit
Aminofusin 1g/kgBB/hr kec.
8cc/jam
Ceftriaxone 1 x 1g (9)
Fenitoin 2x50mg
Paracetamol 4x 10ml
Dexametasone 3x3mg STOP
Nebu ventolin +NS/8jam
Asetazolamid 3x150mg
R/H/Z/E 150/100/350/200
O2 nasal 1 l/m
Ceftriaxone 1x 850 mg (13)
Ampisilin 4 x 850 mg (13)
Ca glukonas 5 cc dalam D5 50 cc
(1jam)/8jam hari kedua

21-7-15: Hb 11,6 WBC 19900 Ht 35 Plt 450.000 MCV 74,8 MCH 25 MCHC 33 LED 25
DC 0/0/84/8 ret: 1,0 BSS 124 Ureum 9 Cr 0,31 Ca 9,0 Na 144 K 4,1 CRP 6
22-7-15: LCS: tidak bewarna, agak keruh, tidak berbau, BJ 1.020 bekuan (-) LEUKOSIT
192 pmn 38 mn 63 nonne + pandy + protein 0,3 Glukosa 41,3 LDH 218 Cl
108
26-7-15: Mantoux test: (-)
27-7-15: Hb 15,1 Ht 42 WBC 12.200 Plt 179.000 DC: 0/0/89/7/4 SGOT 142 SGPT 170
Alb 3,4 Protein Total 6,4 ur 5 Cr 0,18 As. Urat 3,4 Ca 8,5 Na 136 K 3,3 Cl 102

Keterangan

30-7-15: SGOT: 44 SGPT: 37 Albumin 4,7 Ureum: 38 As. Urat: 5,90


Creatinin: 0,41 Ca: 10,2 Mg: 2,18 Na: 139 K: 4,7 Cl: 104 FIO2 : 40
pH: 7,424 pCO2: 29,6 pO2: 109,4 Na+: 133,8 K+: 3,31 HCO3: 19,5
BEb: -3,2

RABER RESPIRO
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Aden S/Lk/17-112011
BB: 10kg PB: 50 cm
BB/U <-3 PB/U -2 s/d
0 SD
BB/PB : <-3 SD
15013462/903139
MRS 21-7-15

Satria N A/ Lk/9-1114
BB: 7,1kg PB 84cm
BB/U: PB/U:
BB/PB:
LK: 47 cm
15018935/903080
MRS:

Penurunan Kesadaran
ec. Meningitis TB

BP + Meningitis

O2 nasal 1 l/m
Ceftriaxone 1x 850 mg (10)
Ampisilin 4 x 850 mg (10)
Fenitoin 2 x 45 mg
Zinc 1 x 20 mg via ngt
Ca glukonas 5 cc dalam D5 50 cc
(1jam)/8jam

LK: 51 cm

24-7-17: Bilasan Lambung BTA I(-), BTA II (-)


20-7-15: Hb 10,7 WBC 4.400 Ht 32 Plt 35 MCV 73,4 MCH 24 MCHC 33 LED 11 DC
0/0/55/26/19 Ret 0,9
AGD: FIO2 40% pH + 7.295 pCO2 48,7 pO2 39,5 SO2 57,2 Na+ 132,2 K+
3,99 HCO3 22.9 BEb -3,0 SGOT 2232 SGPT 728 Protein total 8,1 Albumin 3,8
GDS 199 Ureum 102 Creatinin0,59 Ca 7,0 Na 136 K 5,3 Cl 108
LCS: tidak bewarna, agak keruh, tidak berbau BJ 1.020 bekuan (-) pH 9,0
Lekosit 385 PMN 77 MN 23 Sel blast (-) nonne (+) pandy (+) protein 0,1 LDH
146 Glukosa 142,2 Cl 124
22-7-15: Hb 7,3 WBC 10.400 Ht 21 Plt 62.000 MCV 73,1 MCH 25 MCHC 34 LED 2 DC
0/0/77/12/11 Fe 99 TIBC 211 Ferritin 442,4 Ur 24 As. Urat 3,8 Ca 7,8 Phospor
4 Na 140 K 3,4 Cl 105
GDT mikrositik hipokrom dengan trombositopenia
AGD: FIO2 50% pH 7,426 pCO2 47,2 PO2 40,7 SO2 60,9 Na+ 136 K+ 2,59
HCO3 31,3 BEb 6,8
Kultur Urine: steril
26-7-15: Hb 7,8 WBC 10.000 Ht 24 PLT 210000 DC 0/0/60/20/20 Alb 3,1 Cl 8,3 Na
137 K 3,8 Cl 107

LK: 44 cm

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Ratih Amalia/Pr/26-22015
BB: 6 kg PB:66 cm
BB/U: -1,07 PB/U +1
BB/PB:-2,25
Lk: 43 cm
(normocephali)
903885/15019424
MRS: 24-7-15

Penurunan Kesadaran
ec. Meningitis
bakterialis +
Hemangioma R.
frontalis

Ampisilin 3x500mg (11)


Ceftriaxone 3x 60mg (11)
Diazepam bila kejang
Nebu Ventolin+ NS/ 8 jam

M. Sulton Attamami/
Lk/21-12-2013
BB: 9,5 kg
PB: 79 cm
BB/U: -1,47 PB/U:
-1,62
BB/PB: -0,94
LK: 46cm
901093/
MRS: 04-07-2015

Meningitis
Bakterialis + BP

O2 sungkup 5L/m
D12,5 kec 30cc/jam
F100 8x 100cc
Gliserol 3x20cc
Meropenem 3x200mg
(20)STOP
Nebu Ventolin + NS/8 jam
Abbotic (claritromycin)

Marwah/ Pr/ 1th 9 bln


BB 6,8 kg PB: 73 cm
BB/U:-4,10 PB: -3,80
BB/PB: -2,95
LK: 46 cm
RI 15016408/ 899027
MRS 21-6-15

Meningitis
Bakterialis

OAT (INH 75mg/ Rifampisin 75


mg/ PZA 150mg/ Etambutol
75mg) (17)
Haloperidol 2x0,07 (10)
Ampisilin sulbactam 3 x 350
mg (8)
Amikasin (11) rencana besok
ganti cotrimoxsazole oral
Beclofen 3x 1,2 gr
Prednison - - (2)
R/ fisioterapi

24-7-15: Hb 11,4 WBC 5.500 Ht 33 Plt 66.000 MCV 73,4 MCH 25 MCHC 34 LED 2 DC
0/4/66/20/10 SGOT 2275 SGPT 2737 Protein total 4,9 Alb 3,1 BSS 81 Ur 25 As.
Urat 6,4 Cr 0,35 Ca 7,9 Na 143 K 4,4 Cl 119 CRP <5
LCS: kekuningan, jernih, tidak berbau, BJ 1.020 pH 9 leu 305 PMN 82 MN18
Nonne pandy + prot 0,1 LDH 530 Gluk 67,6 Cl 113

EEG brain
monitoring
(7-8-15)
LK: 42 cm

4-7-15: Hb 10,5 WBC 9700 Ht 32 PLT 117.000 MCV 75,5 MCHC 33 LED 35
DC 0/0/68/24/8 BSS 66 Na 140 K 40 Cl 113 Ca 66 CRP 44 LCS tidak
berwarna, jernih, tidak berbau, BJ 1020 bekuan pH 9 leukosit 96
PMN 76 MN 24 sel blast nonne pandy + protein 0,1 LDH 40
Glukosa 71,7 Cl 132
7-7-15: : Hb 10,5 WBC 7000 Ht 32 PLT 258.000 MCV 75,5 MCHC 33 LED 35
DC 0/0/76/18/6 SGOT 197 SGPT 157 Alb 3,6 Bss 108 102 Ur 35 Cr
0,29 Ca 9,1 Phosfor 3,5 Na 143 K 5,1 Cl 113
26-7-15: Hb 13,3 Ht 40 WBC 13,3 Plt 565.000 MCV 81,1 MCH 27 MCHC 34
LED 18 DC 0/0/50/35/15 Ca 10,0 Na 144 K 4,1 Cl 113
Hb 11,0 WBC 5.000 Ht 32 Plt 144.000 LED 2 DC 0/0/60/30/10 GDS 120 Ca
8,3 Na 138 K 2,624-6-15 Ca 7,7 Na 139 K 4,0 LCS tidak berwarna, jernih, BJ
1,020 bekuan (-) pH 8 Leu 65 PMN 88 MN 12 Nonne (-) Pandy (+) Prot 0,1
LDH 33 Gluk 94,6 Cl 127
25-6-15 Na: 136 K: 4 Cl: 103 Ca:7,9
27-6-15 Ca 8,8 Na 136 K 3,6 Cl 107
8-7-15: Hb: 9,8 Leukosit 8.000 Ht 30 LED 22 DC: 0/5/68/20/7
Kultur darah : Steril
9-7-15: kultur urine: candidiasis albicans (yeast(+)pseudohypa(+))
>100.000/ml
9-7-15: bilasan lambung BTA I (-)
10-7-15: LCS: tidak berwarna, jernih, tidak berbau, BJ 1.020 Bekuan (-) pH
8,0 lekosit 71 PMN 82 MN 18 Sel blast (-) nonne (-) pandy (+)
protein 0,1 Glukosa 75,9 LDH 50 Cl 131
LCS: BTA (-) bilasan lambung BTA II (-)
10-7-15: kultur LCS: S. Epidermidis, Sensitif (vankomycin,
Amikacin)
13-7-15: bilasan lambung III (-)
14-7-15: Hb 8,6 WBC 9.700 Ht 25 Plt 438.000 MCV 78 MCH 27 MCHC 35
LED 32 DC 0/1/66/24/7 Ret 1,4 SGOT 64 SGPT 53 Ureum 9

LK: 47 cm

O2 nasal 2L/menit
Ampisilin 3x500mg (6)
Ceftriaxone 3x 60mg (6)
Dexametasone 3 x 2 mg (6)
Ranitidine 2 x 10mg
Diazepam bila kejang

Raber gizi dan


infeksi

LK: 45 cm

IVFD D5 NS gtt 6x/m


Inj. Vancomycin 3 x 150 mg
Paracetamol 4 x 1 cth
Fluconazole 1x45mg (14)
STOP
OAT (INH 75mg/ Rifampisin 75
mg/ PZA 150mg/ Etambutol
75mg)
BSB 3 x 30 cc
F75 8x 30 cc
Fisioterapi
Inj. Acyclovir 3 x 70mg
(17)STOP
Inj. Dexametason 3x 2mg (5)
stop
Inj. Ampicillin 3x 700mg (10
stop)
Amino steril 6% kec. 5,7cc/jam
Haloperidol 2x0,07 (7)
Ampisilin sulbactam 3 x 350
mg (3)
Gentamisin 2 x 15 mg (7)
Metronidazol2 x 50 mg (7)
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Erik Syaban/Lk/ 2-615


BB: 4,6 kg
904927/15019998
MRS: 30-7-15

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Herli bin
Asmawi/Lk/11-022015
BB: 6 kg PB: 64 cm
BB/U -2,19 PB/U
-1,90
BB/PB: -1,97
LK: 46 cm
(normocephali)
15019468/903905
Mrs: 24-7-15

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Aiko Alvaro/Lk/30-122014
BB: 6,9 kg PB: 64
cm
BB/U: -1,62
PB/U:
-2,29

Creatinin 0,22 As urat 1,8 Ca 8,2 Na 138 K 3,2.GDT: anemia


Mikrositik normokrom, anisositosis, fragmentosit (+) sel target (+)
Hb elektroforesa, cek status besi,monitor darah tepi
16-07-15:Hb 8,2 WBC 8.000 Ht 24 Plt 433.000 LED 44 DC 0/3/59/31/7 Bil.
Total 0,27 Bil. Direk 0,12 Bil Indirek 0,15 SGOT 145 SGPT 81 Alb 3,3
Glo 2,4 ureum 5 as. Urat 1,3 Creatinin 0,18 Ca 8,1 Na 139 K 2,8 Cl
112 Phosfor 3,1 CRP <5
24-7-15: Hb 9,2 WBC 7.400 Ht 27 Plt 544.000 MCV 82 MCH 28 MCHC 34
LED 9
DC 0/1/67/21/11 SGOT 34 SGPT 67 Ureum 21 As Urat 4.7 Cr 0,24
Ca 8,3 Na 137 K 3,1 Cl 101
Kultur Urine: Steril
23-7-15: Kultur Abses : S.Epidermidis

Penurunan
kesadaran ec. Susp.
Peningkatan TIK ec.
SAH + hidrocephalus
(ventrikulomegali) +
anemia ec. Susp.
Perdarahan DD/ def.
Fe
Kejang demam ec.
Meningitis bakterialis
+ anemia + hidrocele
+ hernia umbilicalis

IVFD D5 NS 20xmikro
R/ Operasi elektif
R/ transfusi PRC 1X80mg

Ivfd. D5 Ns gtt 6x/mnt makro


Ampicilin 3 x 600 mg (5)
Ceftriaxone 1 x 600 mg(5)
Dexamethasone 3 x 2 mg(5)

24-7-15: LCS: tidak bewarna, agak keruh, tidak berbau, BJ 1.020 bekuan (+) pH 8.0
Lekosit 482 PMN 42 MN 58 Nonne (-) Pandy (+) Protein0,1 LDH 0,22 Glukosa 39,5 Cl
135
27-7-15: Hb 11 WBC 14.400 Ht 35 Plt 344.000 DC 0/0/86/13/1

LK: 42 cm

Meningitis Bakterialis

O2 nasal 1L/menit
IVFD
Ampisilin 3 x 700 mg (4)
Ceftriaxone 1 x 700 mg(4)
Dexametasone 3 x 2mg(4)
Diazepam 2mg bila kejang

27-7-15: Hb 11,7 Ht 33 WBC 7.200 Plt 58.000 DC 0/1/33/60/6 GDS 167 SGOT 1068
SGPT 190 Ureum 19 Creatinin 0,26 Ca 7,8 Na 113 K 4,8 Cl 100
LCS:kekuningan, agak keruh, tidak berbau, BJ 1.020 bekuan (-) pH 9,0 Lekosit
103 PMN 69 MN 31 nonne (+) pandy (+) Protein 0,1 LDH 28 Glukosa 107,5 Cl
114
28-7-15: Hb 9,4 Ht 27 Plt 23.000 WBC 4.500

LK: 41 cm

BB/PB: -0,22
LK: 42
cm(normocephali)
15019602/904047
MRS: 27-7-2015

USG Abdomen :efusi pleura dextra minimal + asites +


29-7-15: Hb 8,2 Ht 24 WBC 6.100 Plt 31.000 DC 0/0/27/54/19
29-7-15: Hb 9,4 Ht 28 Plt 83.000 WBC 12.700 DC 0/0/33/52/15 Ca 8,0 Na 136 K 4,2
Cl 9,5
30-7-15: Hb: 8,5 Ht 25 Plt 62.000

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M. Fransisko/Lk/ 2010-13
BB: 11kg PB: 80 cm
LK: 45 cm
15014152/905183
MRS: 31-1-2015
M. Novriansyah/
Lk/16-11-08
BB: 18 kg PB 112 cm
LK: 51,5 cm
905212/15020191
MRS: 1-8-2015
Mixdal Reder/
Pr/ 27-12-13
BB : 7,2 kg PB: 82
cm
LK: 48cm 44cm
BB/U=-2,14
PB/U=-0.72
BB/PB=-2,47
15015304/ 897124
MRS 09-6-15

Kejang tanpa
demam ec. Susp. SOL
dd/ Epilepsi

KDK +
tonsilofaringitis Akut

Meningitis TB + BP
Pneumonia lobaris
(D)

IVFD D51/4 NS gtt.


10x(makro)/menit
Bila kejang Fenitoin 200mg 2
x 50mg
O2 nasal 2 L/menit
R/ CT scan Kepala
Amoksisilin 3 x 250 mg
PCT 3x 250mg bila > 38,5 c
Diazepam 3 x 5mg

31-7-15: Hb 12,4 WBC 16,8 Ht 38 Plt 398.000 DC 0/1/64/32/3 BSS 135 Ca 8,8 Na
147 K 4,1

O2 nasal 1 L/ menit
Fluconazole 1x120mg
Baclofen 3x2mg p.o
Ventolin+NS Nebu 3x 1amp
Dexametasone 3x3 mg(stop)
Claritromicyn 2x100mg
R/H/Z/E : 150/80/300/160 (10)
BSB 3X100
F100 8X60ml

7-7-15 kultur darah steril


10-6-15 LCS tidak berwarna, agak keruh, BJ 1,01 bekuan (-) pH 8,0 Leu 360
PMN 68 MN 32 Nonne (-) Pandy (+) Prot 0 Glukosa 64,9 LDH 66 Cl 130
Kultur urine: steril
17-6-15 Hb 11,1 WBC 13.600 Ht 24 Plt 267.000 LED 100 DC 0/0/77/11/12
SGOT 236 SGPT 18 Alb 3,2 Ur 7 As.Urat 3,0 Cr 0,19 Na 145 K 4,2 Cl 110
CRP 69
19-6-15 Hb 12,4 WBC 40.500 Ht 38 Plt 571.000 LED 11 DC 0/0/87/8/5 SGOT
140 SGPT 21 Prot.Total 6,1 Alb 3,6 Glb 2,5 Ur 3 As.Urat 2,3 Cr 0,20 Ca 9,2
Na 141 K 4,0 CRP 103
24-6-15 SGOT 158 SGPT 24 Alb 3,4 Ur 10 Cr 0,25 As.Urat 2,9 Ca 9,0 Na 141
K 3,4 Cl 92
8-7-15 : Hb: 19,8 Leuko: 9,3 Ht: 31 Trombosit: 267 LED: 36 DC:
0/6/43/33/18 Ureum: 12 as.urat:2,6 Creatinin: 0,21 Ca:9,1 Na: 142 K: 4,3
Cl: 105 CRP: 61
12-7-15: Tes mantoux (-)
13-7-15: Hb 9,8 WBC 7.600 Ht 30 Plt 365.000 MCV 72.2 MCH 24 MCHC 33
LED 34 DC 0/1/71/24/4 Retikulosit: 1.4 SGOT 240 SGPT 72 Ureum 10
As.Urat 1,90 kreatinin 0,19
Bilasan Lambung BTA I (-), BTA II(-)
16-7-15: hb 9,4 WBC 7.200 Ht 30 Plt 286.000 LED 33 DC 0/2/27/52/19 Ur
12 Cr 0,18 As urat 2,3 CRP 230
22-7-15: Hb 9,8 WBC 30.000 Ht 32 Plt 1.158.000 MCV 75 MCH 23 MCHC 31
LED 74 DC 0/0/68/20/11 SGOT 172 SGPT 228 Ur 17 As.urat 4,7 Cr
0.23 Ca 9,1 Na 143 K 5,3 Cl 105 CRP 118
27-715: Hb 10,4 Ht 34 WBC 21.700 Plt 600.000 MCV 78,4 MCH 31 MCHC 31
LED 57 DC 0/0/75/17/8 Ret: 3,7 SGOT 202 SGPT 194 Protein total
7.5 Alb 3,2 ur 26 Cr 0,23 As. Urat 12,2 Ca 9,0 Na 146 K 6,2 Cl 110
30-7-15: Ca 9,1 Na 139 K 3,5

O2 nasal 1 L/ menit
Fluconazole 1x120mg
Baclofen 3x2mg p.o
Ventolin+NS Nebu 3x 1amp
Dexametasone 3x3 mg(stop)
Azitromisin 1 x150 mg
R/H/Z/E : 150/80/300/160 (7)

LK: 44 cm

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LANTAI 3
Abiyyu danial
Ghaisan/
Lk/8-5-2014
BB: 5,4 kg PB: 63,5
cm
LK: 42,5 cm
905196/15014162
MRS: 31-7-15
Panji Naufal Al
Bhadrika/Lk/22-08-13
BB: 8,5kg PB: 78cm
BB/U: -3,01 PB/U:
-2,99
BB/PB: -2,12
LK: 38 cm
(mikrosefali)
15019447/903895

Penurunan
Kesadaran ec.
Meningitis Bakterialis

IVFD D5 NS gtt. 24 x/mikro


Cefotaxime 3 x 500mg
Vancomycin 4 x 75 mg
Dexametasone 3 x 2 mg
Pct 4 x 6 cc
Diet F100 6 x 100 cc (Soya)
O2 nasal 1 L/menit

31-7-15: Hb 12,4 WBC 9.300 Ht 36 Plt 162.000 LED 8 DC 0/1/47/39/13 Na 137 K 4,4
Cl 104 CRP 11
LCS: tidak bewarna jernih, tidak berbau BJ 1.020 pH 8 bekuan (-) lekosit 217
PMN 79 MN 21 sel blast (-) nonne (-) pandy (+) protein 30 LDH 83 Glukosa
64,8 Cl 120

Kejang tanpa demam


ec. Susp Epilepsi +
GDD + muntah
Profuse

STOPPER
Depakene 2 x 2,5 cc
Urdafalk 3x80mg
Clonazepam 2x0,05 mg (3)
R/ fisioterapi

24-7-15: Hb 13,1 WBC 11.300 Ht 37 Plt 94.000 MCV 87,3 MCH 31 MCHC 35 Led 6 DC
0/2/11/73/14 SGOT 69 SGPT 18 Ca 9,4 Na 148 K 4,3

MRS: 24-7-2015
M. Fariz Azhari/ lk/
10bln
15016417/ 854529
8,3kg/ 70cm/ 51cm
MRS 21-6-15

Hidrosefalus Post
VP shunt + CP +
susp. Epilepsi +
keratitis eksposure
ODS + atropi papil
bilateral

Inj. Ceftriaxon 1x 900mg


(15)STOP
Inj. Ampicilin 3x 900mg
(15)STOP
Asetazolamid 3x 60mg
Pyridoxin 3x 5mg
Lameson 3x 1mg
Carbamazepin 3 x 40mg p.o.
Susu 12x75 cc
PCT 3 x 100mg
Floxa 1 gtt ODS/jam
Vigamox 1gtt ODS/jam
As fusidat cr 2xsue
Manitol3 x 20cc
Cefotaxime 2x100mg(3)
Balance cairan/6jam

21-6-15 Hb 10,5 wbc 15.600 Ht 32 Plt 606.000 LED 17 DC 0/1/62/30/7 GDS


117 Ca 9,9 Na 142 K 4,3
28-6-15 Hb 12 WBC 23.700 Ht 38 Plt 766.000 LED 17 DC 0/0/57/30/13 CRP
15
2-7-15: Urinalisis: dbn
8-7-15: Hb: 9,7 Leuko: 5,100 Ht: 30 Trombo: 510.000 LED: 43 DC:
0/0/29/51/20 Ur: 14 As.urat: 2,10 Cr: 0,18 Ca: 8,1 Na: 136 K: 4,0 Cl: 109
CRP <5
30-6-15: kultur darah steril
3-7-15: kultur urine steril
10-7-15: Bilasan Lambung BTA I(-), BTA II (-) BTA III (-)
22-7-15: hb 10.9 ht 35 plt 697.000 WBC 11.600 MCV 73,1 MCH 23 MCHC 31
LED 47 DC 0/1/48/40/11 SGOT 42 SGPT 45 UR 15 Cr 0,16 As.urat 2,1
Ca 8,8 Na 143 K 5.2 Cl 112
27-7-15: Hb 9.8 WBC 17.800 Ht 31 Plt 429.000 DC 0/1/73/19/7 SGOT 31
SGPT 37 Protein total 5,7 Alb 3.3 Ur 5 Cr 0,22 As.urat 2,7 Ca 8,2 Na
142 K 3,5
23-7-15: kultur urine: Klebsiella pneumoniae( S: amikacin,
Chloramphenicol, fosfomycin)

LK: 52 cm

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