A 13-year-old male presen...

A 13-year-old male was admitted to the hospital with the chief complaint of fever since four days before admission. The fever was abruptly high, and the temperature only went down after the child was given antipyretics, but the temperature never returned to normal. The symptom was also followed by pain in the epigastric region, nausea, and vomitus more than three times a day for about 50 cc volume every time the boy threw up. In the physical examination, the patient was alert (GCS 15). The body temperature was 38°C, and the other vital signs were normal. Nutritional status showed the patient was obese (weight 88 kg (BB/U > 95th percentile); height 170 cm (TB/U 95th percentile); BMI 30,4 (IMT/U > 97th percentile)). The patient had a round face and a double chin. The abdomen was distended with abdominal skin folds and tenderness in the epigastric region. There was no bleeding manifestation, and the other examination was normal. Laboratory results showed hemoglobin 15 g/dL, leukocytes 1.490 x106/µL, hematocrits 44%, platelet 75 x 109/L, normal differential count. NS-1 antigen showed a positive result. Chest Xray showed normal heart and lung. The patient was then diagnosed with dengue with warning signs and was treated based on the Group B Dengue Treatment algorithm. On the 2nd day of hospital admission, mucosal and gum bleeding were found, followed by increased hematocrit levels by 55% and a decrease in platelet count to 30 x 109/L. The patient was then monitored for vital signs, fluid balance and diuresis, bleeding and shock manifestations. Any clinical deterioration was observed if the patient's condition worsened to severe dengue.