DEATH REVIEW

MARCH
2024

Blue Unit

Dr. Mohammad Sakirul Islam

Phase B, Y-3 Resident
Department of Pediatric Hematology & Oncology
 TOTAL NO OF ADMISSION-
25

ONCOLOGY CASE- HEMATOLOGY CASE-

24 1

NEW CASE OLD CASE-

10 14
Total number of admission in March, 2024
Total New OLD

ALL 8 3 5
AML 2 1 1
Wilm Tumor 2 1 1
HB 3 1 2
ES 1 1 0
Medulloblastoma 1 0 1
NHL 4 2 2
NB 2 0 2
Germ Cell Tumor 2 1 1
ITP 1 1 0
Total 25 11 14
Percent distribution of patients

NB; Series1; 8.69565217391304;

9%
ITP; Series1; 4.34782608695652; 4% ALL AML Wilm Tumor

HB ES Medulloblastoma

ALL; Series1;
NHL; Series1; 34.7826086956522; 35%
13.0434782608696; 13%

NHL NB ITP
Medulloblastoma; Series1;
4.34782608695652; 4%

ES; Series1; 8.69565217391304;

9%
HB; Series1; AML; Series1;
17.3913043478261; 17% 4.34782608695652; 4%
Wilm Tumor; Series1;
4.34782608695652; 4%
 Number of Death
ADMITTED DEATH PERCENTAGE
PATIENTS (%)

4%
Total 25 1
number of
cases

Oncological 24 1 4.2%
cases
Hematologic 1 0 0%
al case
 Death Profile
Name, Diagnosis Day of Date of Duration of Cause of death
Age admission death hospital
stay

1 Zedan , Acute ALL (B cell ) with

13year Lymphoblastic 23 March 27 March 5 days septicemia
Leukemia 2024 2024 (Pneumonia with
(B Cell) Pancreatitis )wit
h hyperglycemia
with
AKI with
Hypertensive
encephalopathy
with
Coagulopathy
with Electrolyte
imbalance with
hypocalcemia
CASE SUMMARY

Zedan, 13 years old boy, 2nd issue of his non consanguineous

parents hailing from Brahmanbaria was admitted as a
referred case from PICU of a private clinic with the diagnosis
of Acute Leukemia with Pneumonia with pancreatitis with
septicemia with Acute Kidney Injury with coagulopathy
 CASE SUMMARY
He was admitted there with the complaints of
• Fever & progressive pallor for 20 days
• Cough and respiratory distress for 10 days
• Upper abdominal pain and vomiting for 7 days

He was treated there for 6 days with

• Injectable antibiotics -Tazobactam+piperacilin & Linezolid
• PRBC and RDP transfusion
• other supportive management.
• Due to financial constraints,they were shifted to bsmmu on 23/3/2024
ON EXAMINATION
 MiILLldely pale

 Ill looking,Toxic
 Pale
 Temp :102 0 F
 Pulse : 112 b/ min
 Respiratory rate : 28 breaths/min,SpO2- 95% with 3L/min oxygen
 BP : 110/70 mmHg
 Lungs: Vesicular breath sound.
Rhonchi in both lung
 Heart : S1+S2+0
 No lymphadenopathy
 Dehydration-Absent
 Skin survey-Echymosis present in both lower limb
 P/A/Ex-soft,distended,
Ascites -present
Liver- Enlaged,4cm from RCM along mid clavicular line,
firm in consistancy with smooth surface
 Investigation

C CBC (23/3/2024)

Hb : 9.1 gm/dl.
TC : 500/ cumm.
Neutrophil - 12% (ANC-60)
Lymphcyte- 80%
Monocyte- 4%
Eosinophil-4%
Basophil-0%
Platelet: 30000/cumm

PT-13 sec
APTT-22sec
INR-1.08
Investigation
SGPT: 25 U/L
S. Creatinine: 1 mg/dl
S.Uric Acid 13.3 mg/dl
eGFR 64%
S calcium 1.27 mmol/L
Electrolytes
Na-136 mmol/L
K-3.2 mmol/L
Cl-100 mmol/L
Investigation
S.LDH 2730 U/L
S.Inorganic Phosphate 9.7mg/dl
CBG 10.5 mmol/L
S.Lipase 229 U/L
S.Amylase 160 U/L
S.Albumin 3.3gm/dl
D dimer 7.28mg/dl

Blood c/s,Urine c/s-pending

• 3
Xray chest AP view (22.3.24)
Treatment :
 Neutropenic diet
 IV Fluid
 Inj Tazobactum+Piperracillin
 Inj Linezolid
 Inj Calcium gluconate
 Inj Paracetamol
 Tab.Allopurinol
 Tab.Entacyd
 Nystat oral drop
 Oralon mouth wash
 Blood product transfusion
 Nebulization with Windle Plus
 Follow up (23/3/2024 , 5 pm) (HS-1)
•SUBJECTIVE OBJECTIVE ASSESSMENT PLAN
 Fever persist Sick
 Convulsion - looking ,restless,conv Convulsion is due to Oxygen inhalation
GTCS , ulsive Hypertensive Bed rest in lateral
2episode,persist Mildly pale enceplalopathy position
for 5 minutes Temp – 103℉ & Hyperglycemia Added:
HR:122 bpm Inj Phosphenyton
RR: 32/min,SP02- Inj frusemide
85% in 3L/min Nifedipine
oxygen Inj .Napa
Getting- BP: 180/130 Send
Tazobactam+ mmHg(above 99th RBS,electrolyte,calcium,
Piperacillin centile) magnesium
day 5 Heart : S1 +S2 + 0
Inj.Linezolid Lung: Vesicular breath Send
Investigation:
day 5 sound, Rhonchi ,creps S.Electrolyte
CBG 20.9 mmol/L
CBG-21 mmol/L in both lung field S.Calcium
P/A-Soft, distended, Na-138mmol/L S.Magnesium
Bowel sound-present K-3.0 mmol/L
Liver-4cm Cl-100 mmol/L
Skin survey- Ca 1.3 mmol/L
Echymosis present
Plan :
Bowel -moved
Add insulin with monitoring
of blood glucose
 Follow up (25/3/2024 , 9 am) (HS-3)
•SUBJECTIVE OBJECTIVE ASSESSMENT PLAN
 Fever persist Sick looking ,restless
 Increased Mildly pale Deteriorating Oxygen inhalation
respiratory Temp – 102℉ increased
distress HR:115 bpm Antibiotic change to
RR: 34/min,SP02- Meropenem +
82% with 6L/min Vancomycin
oxygen
BP: 110/80 mmHg Add Hydrocortison &
Heart : S1 +S2 + 0 antifungal
Getting- Lung: Vesicular breath
Tazobactam+ sound, Rhonchi and Investigation
Piperacillin Crackels in both lung Hb-7.5gm/dl
day 7 field TC-400,ANC-40 Send CBC,creatinine
Inj.Linezolid P/A-Soft, distended,
PLT-13000/cmm Electrolyte,PT,APTT,D
day 7 Bowel sound-present dimer
Clarithromycin Liver-4cm Na-140mmol/l, Xray Chest
day 2 Skin survey- K-2.5mmol/L
Echymosis present Blood & urin C/s-no
Insulin-D3 Bowel -moved growth
CBG-12.5mmol
D-dimer-5.2
PT-12sec,APTT-41sec
InR-1.5
Creatinine-1.2
Xray chest AP view (26.3.24)
 Follow up (27/3/2024 , 5pm) (HS-5)

•SUBJECTIVE OBJECTIVE ASSESSMENT PLAN

 Fever persist Sick looking ,restless
 Respiratory Mildly pale Deteriorating Shift the patient to PICU
distress Temp – 101℉
HR:132 bpm Inj hydrocortisone
RR: 32/min,SP02- Inj frusemide
65% with 10L /min Nebulization
oxygen
Getting- BP: 100/75mmHg
Meropenem Day -3 Heart : S1 +S2 + 0
Vancomycin Day 3 Lung: Vesicular breath
Clarithromycin Day sound, Rhonchi and
4 crackels in both lung
Voriconazole Day3 field
P/A-Soft, distended,
Bowel sound-present
Liver-4cm
Skin survey-
Echymosis present
Ascites -present
Intake-
Output
Bowel -moved
CBG-8.8mmol
Follow up (27/3/2024) @ 6PM

Respiration: Absent
Pupil: Dilated, fixed & not reacting to light.
HR: Not recordable
BP: Not recordable

Patient was declared dead @ 6:30pm

Thank you