Suriyati 59 y.o, fw (dr.

Rio)
cc : Fever since 2 days ago Present Illness History : Fever since 2 days ago, high fever Swelling with pus since 1 weeks ago, red, pain (+) Blurry eyes since 1 months ago History of DM since 3 years ago, regular controlled in 2 years and not controlled in 1 years ago.

Physical Examination : GA : Moderate, Consc : CMC, BP : 130/80 HR : 97x/I, RR : 24x/I, T : 38,8 C Eyes : Icterus -/-, anemis -/Lung : Vesikuler, rh -/-, wh -/Cor : Bruit , regular rhtym Abdomen : H/L not palpable, bowel sound (+). Extremitas : inspection : mass size like marbles, red (+), pus (+) palpation : mass size 3 x 2 x 2 cm, fluctuation (+), warm (+)

Lab : Hb : 10.2 gr/dl Leukosit : 19.300 /mm3 Trombosit : 296.000 Ht : 31% Na/K/Cl : 129/4,5/98 Ur/cr : 29/1,1 GDS : 212 mg/dl

WD/ Sepsis ec abses pedis dextra DM type II uncontrolled overweight Th/ Rest/ DD 1900 kkal IVFD NaCl 0,9 % 6 h/kolf Ceftriaxone 1 x 2 gr Ciprofloxacin 2 x 200 mg Ascardia 1 x 80 mg Paracetamol 3 x 500 mg

Drip insulin 50 unit in 500 cc NaCl 0,9%(microdrips), check BGR/ hours if: BGR Insulin <80 5 gtt/I + bolus D40% 1 flc 80-110 10 gtt/I 110-160 15 gtt/I 160-220 20 gtt/I >220 25 gtt/I + bolus insulin 8 unit

Check K / 6 hours if : K correction <3,5 40 mEq 3,5-4,5 20 mEq 4,5-5,5 10 mEq >5,5 o Apply catheter fluid balance

Alisini, 62 y.o, HCU, dr. Rio

cc : Decrease of conciousness since 1 days ago Present Illness History : Decrease of conciousness since 1 days ago Fever since 1 weeks ago Coughing since 1 weeks ago, blood (-) Yellow eyes since 2 weeks ago Right abdomen pain since 2 weeks ago, thrill to back Mixturation since 2 weeks ago Black defecation since 1 weeks ago

Physical Examination : GA : Bad, Consc : Somnolen, BP : 100/70 HR : 100x/I, RR : 32x/I, T : 36,9 C Eyes : Icterus -/-, anemis +/+ Lung : Bronchovesiculer, rales +/+ in lung basal Cor : reguler rhtym, Bruit Abdomen : liver palpable 2 fingers bac, 2 fingers bpx, soepel consistention, flat. Soepel schoefner 2 Extremitas : flapping tremor (+), palmar eritem (+)

Lab : Hb : 5,4 gr/dl Leukosit : 17.400 /mm3 Trombosit : 40000 /mm3 Ur/cr : 60/0,9 Na : 119 mmol/l K : 4,5 mmol/l Cl : 88 mmol/l SGOT : 183 SGPT : 44

WD/ Decrease of conciousness ec hiponatremia ec low intake BP duplex (CAP) Severe anemic normochrom normocitic ec acute bleeding Spontan bacterial peritonitis ec liver chirrochis post necrotic std decompensata DD/ Precoma hepaticum ec chirrocis liver post necrotic std decompensata Ischemic wide extensive

Th/ Rest/Hepar diet I via NGT IVFD NaCl 3% 12h/k (2 kolf) Drip ornisphar 2 amp in NaCl 0,9 % 500 cc in 8 hours Inj Cefotaxim 3 x 2 gr Vit k inj 3 x 1 amp Madopar 3 x 1 tab Lactulac syr 3 x C1 Curcuma tab 3 x 1 Ascardia 1x80 mg Lansoprazol 1x30 mg Syr ambroxol 3xc1 Crossmatch transfusion prc until Hb > 8 gr/dl

Epa 35 y.o, fw (dr. Eka)

cc : Fever since 3 days ago Present Illness History : Fever since 3 days ago, high fever Wound on right foot since 1 months ago Patient has been known BGR : 500 mg/dl at puskesmas, not regular controlled. History of hungry, thirsty, often mixturation since 2 months ago Patient has been known hospitalized at RST because of wound

Physical Examination : GA : Moderate, Consc : CMC, BP : 100/60 HR : 95x/I, RR : 29x/I, T : 38,5 C Eyes : Icterus -/-, anemis -/Lung : Bronchovesikuler, rh +/+, wh -/Cor : Bruit , regular rhtym Abdomen : H/L not palpable, bowel sound (+). Extremitas : RF +/+, RP -/-, wound on right foot

Lab : Hb : 6.2 gr/dl Leukosit : 15.300 /mm3 Trombosit : 738.000 Ht : 18% Na/K/Cl : 132/3,4/104 Ur/cr : 12/0,5 GDS : 232 mg/dl

WD/ Sepsis ec ulcus pedis dekstra with gas gangren DM type II uncontrolled normoweight Lung TB duplex Anemic microcitic hipochrom ec chronic disease DD/ CAP Th/ Rest/ DD 1700 kkal IVFD NaCl 0,9 % 6h/kolf Ceftriaxone 2x 2 gr Ambroxol 3 x C1 Paracetamol 3 x 500 mg Aspilet 1 x 80 mg

Drip insulin 50 unit in 500 cc NaCl 0,9%(microdrips), check BGR/ hours if: BGR Insulin <80 5 gtt/I + bolus D40% 1 flc 80-110 10 gtt/I 110-160 15 gtt/I 160-220 20 gtt/I >220 25 gtt/I + bolus insulin 8 unit

Check K / 6 hours if : K correction <3,5 40 mEq 3,5-4,5 20 mEq 4,5-5,5 10 mEq >5,5 o Apply catheter fluid balance o Redressing ulcus

M.Rahmi, 24 y.o, MW 21, dr. Eka

cc : Fever since 1 weeks ago Present Illness History : Fever since 1 weeks ago Diarrhea since 1 weeks ago Coughing since 1 weeks ago, blood (-) Decrease of appetite since 1 weeks ago Decrease of body weight since 1 months ago Fever (+) Epigastrium pain since 4 days ago Mixturation since 2 weeks ago

Physical Examination : GA : moderate, Consc : CMC, BP : 110/70 HR : 110x/I, RR : 25x/I, T : 38,9 C Eyes : Icterus -/-, anemis -/Lung : Vesiculer, rales -/-, wh -/Cor : reguler rhtym, Bruit Abdomen : H/L not palpable, bowel sound + normal Extremitas : Oedem -/-, RF +/+

Lab : Hb : 11,6 gr/dl Leukosit : 11.300 /mm3 Trombosit : 349.000 /mm3 Ur/cr : 60/0,9 Na : 132 mmol/l K : 3,9 mmol/l Cl : 97 mmol/l GDS : 103 mg/dl

WD/ Sepsis ec BP ( CAP ) Susp SIDA with - candidiasis oral - diarhea P/ VCT Rapid Test CD4

Th/ Rest/fluid diet IVFD NaCl 0,9% 4 h/k Inj ceftriaxone 1 x 2 gr Inf ciprofloxacine 2 x 200 mg Fluconazole 1 x 150 mg Cotrimoxazole 1 x 960 mg PCT 3 X 500 mg Ambroxol 3 x 30 mg

Nurija, 80 y.o, FW 21, dr. Yostila

cc : Vomite since 3 hours ago Present Illness History : Vomite since 3 hours ago History of gastritis since 5 years ago, epigastrium pain when late to eat Fever since 3 days ago Often mixturation since 3 days ago, warm when mixturation

Physical Examination : GA : moderate, Consc : CMC, BP : 110/60 HR : 72x/I, RR : 24x/I, T : 36,2 C Eyes : Icterus -/-, anemis -/Lung : Vesiculer, rales -/-, wh -/Cor : reguler rhtym, Bruit Abdomen : H/L not palpable, bowel sound + normal, epigastrium pain + Extremitas : Oedem -/-, RF +/+

Lab : Hb : 11,4 gr/dl Leukosit : 15.700 /mm3 Trombosit : 356.000 /mm3 Ur/cr : 28/0,9 Na : 137 mmol/l K : 3,8 mmol/l Cl : 105 mmol/l GDS : 158 mg/dl

WD/ Chronic Gastritis Urinary tract infection

Th/ Rest/Gaster diet II IVFD NaCl 0,9% 8 h/k Inj ceftriaxone 1 x 2 gr Domperidone tab 3 x 1 Lansoprazole 1 x 30 mg Sucralfat syr 3 x C1