Case Report

Hypokalemia et causa renal failure et causa

viral infection et causa dengue fever

Prof. DR. dr. Friska Lestari, Sp. PD

Prof. DR. dr. Kamila Adikambang, Sp. PD

Teacher of Professors: dr. Taufiq M. Waly, Sp. Pd

MEDICAL FACULTY OF UNSWAGATI

DEPARTMENT OF INTERNAL MEDICINE

WALED HOSPITAL
Identity

a. Name : Mr. S

b. Age : 35th years old

c. Gender : Male

d. State of marriage : Menikah

e. Education : Junior High School

f. Religion : Islam

g. Job : construction worker

h. Adress : Blok Wage, Dukuh Widare

i. Date of entry to hospital : 29th August 2018

j. Out date from hospital : 1st September 2018

History

Main complaint

Weakness of hands and feet

Current disease history

An elderly patient came to Waled Regional General Hospital with weakness

of hands and feet since 1 day before. The first complaint was felt by the patient.
Previously, patients played soccer at 4:00 a.m. to 5:00 p.m. Then the next day the
patient acts as usual, but in the afternoon the patient feels the body aches. One day
before, complaints of weak hands and feet were felt by the patient when he woke up,
the patient claimed he could not stand. The patient rested 1 day at home, and the next
day was taken to the Waled Regional General Hospital emergency room. Complaints
accompanied by nausea, no vomiting. Fever complaints are denied. defecate and
urinate within normal limits

Medical History

Patients take analgesic drugs 3 tablets (patients forget the name of the drugs)
because of complaints of stiffness 2 days before

Past medical history

a. Hypertension history : denied

b. DM history : denied
c. History of stroke : denied
d. Allergy history : denied
e. History of asthma : denied
f. Heart history : denied
g. History of trauma : denied
h. History of gout : denied

History of family disease

a. Hypertension history : denied

b. DM history : denied

c. History of stroke : denied

d. Allergy history : denied

e. Heart history : denied

Personal social history

a. Patients work as construction workers .Patients

b. eat regularly, do not often eat fatty foods only

c. occasionally, do not consume alcohol

Generalist state

a. General condition : looked sick

b. Awareness: compos mentis

c. Blood Pressure: 120/80 mmHg

d. Pulse: 78x / min

e. RR: 22x / min

f. Temperature: 36.8 ° c

g. Head: Normochepal, conjuntiva is not anemic, sclera is not icteric

h. Neck: lymph node do not feel enlarged

i. Thorax: symmetrical shape and motion, retraction (-)

Heart: cardiomegaly (-) heart sounds S1 - regular pure S2, no murmur,

no gallop

Lungs: left VBS equals right, no rhonki no wheezing

j. Abdomen: flat, soft, normal bowel sound (+), tender pain (-) Liver and spleen
do not feel enlarged,

k. Extremities: CRT <2 seconds, warm acral

Superior extremity

Motoric dextra sinistra

Inspection : normal normal

Palpation : normal normal

Movement : shifted shifted

Strength : 3 3

Tonus : normal normal

Trophy : eutrophy eutrophy

Sensibility

Tactile : +/+

Pain : +/+

Temperature : not done

2 point discrimination : +/+

Position and direction of motion of the joint : +/+

Inferior extremity

Motoric dextra sinistra

Inspection : normal normal

Palpation : normal normal

Movement : shifted shifted

Strength : 2 2

Tonus : normal normal

Trophy : eutrophy eutrophy

Sensibility

Tactile : +/+

Pain : +/+

Temperature : not done

2 point discrimination : +/+

Position and direction of motion of the joint : +/+

Neurological state

Special Examination

Meningeal excitatory stimulation

a. Stiff neck :-
b. Kernig :-
c. Brudzinski I :-
d. Brudzinski II :-
e. Brudzinski III :-
f. Brudzinski IV :-
g. Laseque test :-

Cranialis nerve

a. N.I (Olfactorius) : Normosmia

b. N.II (Optikus D / S) Visus: 6/6
c. N. III, IV, VI ( Okulomotorius, Thoklearis, Abdusens )

Dextra sinistra

Eyeball position Normal Normal

Eyeball movement Normal Normal

- Lateral
Normal Normal
- Medial
Normal Normal
- Nasal Inferior
Normal Normal
- Nasal Superior
Normal Normal
- Upper Lateral
Normal Normal
- Lower Lateral
Normal Normal

Exophtalmus - -
Ptosis - -

Pupil
- Shape
Round Round
- Wide
3 mm 3 mm
- difference in width
- -
- Direct Light Reflexes
Positive Positive
- Consensual Light Reflexes
Positive Positive

d. Cranial Nerve 6 (Trigeminal)

Sensory Right Left
Jaw reflex Normal Normal
Head retraction Normal Normal
Nasal Normal Normal
Cornea reflex Normal Normal

Motor Right Left

M. Temporalis Normal normal
M.Masseter Normal normal
M. Pterygoideus Normal normal

e. Cranial Nerve 7 (Facialis)

Right Left
Patient’s face Symmetric Symmetric
Forehead wrinkles Symmetric Symmetric
Eyebrows height Symmetric Symmetric
Nasolabial fold Symmetric Symmetric
Close eyes Symmetric Symmetric
Cheeks puff Symmetric Symmetric

f. Cranial Nerve 8 ( Vestibulochoclear )

1. Vestibular
Vertigo :-
Nistagmus : -
2. Cochlear
Weber : not evaluated
Rinne : not evaluated
Schwabach : not evaluated
g. Cranial Nerve IX, X (Glosopharyngeal dan Vagus )
Motor
1. Hoaresness :-
2. Arcus pharynx position : normal
3. Uvula position : normal
4. Raising arcus pharynx/ uvula : normal
5. swallow : normal
Sensory
a. Gag reflex : normal
h. N. XI (Spinal Accessory)
1. Shrugging of the shoulders (Trapezius) : normal
2. Turning the head laterally (Sternocleidomastoid : normal
i. N. XII ( Hipoglosus )
1. Tounge position : normal, symmetric
Phsyiologic reflex (right and left)
a. Biceps : normal 2+/2+
b. Brachioradialis : normal 2+/2+
c. Triceps : normal 2+/2+
d. Patellar : normal 2+/2+
e. Achilles : normal 2+/2+
Pathologic reflex (right and left)
a. Babinski : -/-
b. Chaddock : -/-
c. Oppenheim : -/-
d. Gordon : -/-
e. Schaeffer : -/-
f. Gonda : -/-
Laboratory tests
29 August 2018 Haematology
Test Result
Hemoglobin 14,1 %
Hematocrit 40 %
Platelet 178000
MCV 81,9 g/dl
MCH 28,7 g/dl
MCHC 35 g/dl
Erytrosit 4,92
Leukocytes 9700
Band neutrophils 0
Segmen neutrophils 66
Lymphocytes 18
Monocytes 5
Eosinophils 7
Electrolytes serum
Na 146,7
K 1,53
Cl 106,0

Serology
NS1 AG Negatif
IgM Anti Dengue Negatif
IgG Anti Dengue Negatif

Work diagnostic
Hypokalemia et causa renal disfunction et causa viral et causa dengue infection
without fever

Therapy
1. RL 4 hour/500 cc+ KCL 25 meq/6 hours
2. Omeprazole 2x40 mg IV
3. Ondansetron 3x8 mg IV
4. Anbacim 2x1 gr IV
5. Metilprednisolon 2x125 mg
6. Diet more banana
7. Santagesik 3x1 ampul
8. Check blood pressure/3 hours. If systolic <100 give RL 500 cc. If blood pressure
is still low, report to the doctor on duty

30 August 2018
Haematology
Test Result
Hemoglobin 14,5
Hematocrit 43
Platelet 180.000
MCV 83,1
MCH 28,2
MCHC 34,0
Erytrosit 5,14
Leukocytes 8000
Band neutrophils 0
Segmen neutrophils 87
Lymphocytes 11
Monocytes 2
Eosinophils 0

SGOT 36,7
SGPT 27,2
Ureum 34,5
Bilirubin Total 0,55
Calsium 8,33
Na 140,1

30 August 2018
a. Subject : no more complaint from patient
b. Objective :
Blood pressure : 120/80
Motory :
Upper extremity
Right Left

5 5
 Lower extremity
Right Left

5 5

Potassium : 5,41 mg/dl

Eosinophils :0
c. Assesment : Dengue infection day 3
d. Plan :
1. Stop KCL
2. Check electrolyte dan Haemoglobin packet

31 August 2018
a. Subject : (-)
b. Objective :
Consciousness : Compos mentis
Blood pressure : 120/70 mmHg
Heart rate : 84 bpm
Body temperature : 37 celcius
Respiratory rate : 20 times/minute

Thorax :
1. Pulmo : Vesiculobroncho sound +/+ Rhonkhi -/-
wheezing -/-
2. Cor : S1, S2 reguler, murmur -/-, gallop -/-
Extremity : CRT <2
 Motory :
Upper extremity
Right Left

5 5

Lower extremity
Right Left

5 5

c. Assesment :

Hypokalemia et causa renal disfunction et causa viral et causa dengue

infection without fever

d. Plan :
Discharge