Hibak Abdi Hassan, a 2 year 8 month old female, presented with diarrhea for 1 day and vomiting for 1 day. On examination she appeared ill with sunken eyes and was unable to drink. She was diagnosed with cholera based on her symptoms and history of similar illness. She was treated with IV fluids, antibiotics, zinc, and ORS. Her condition improved and she was discharged with instructions on continued ORS and hygiene.

1. Case presentation
• presenter: Dr farah Abdullahi
• Mogadishu university
• Tutor: Dr A/kadir keynan

2. History of personal data
• Name: Hibak Abdi Hassan
• Age: 2 years and 8 months
• Sex: female
• Residence: Hodan
• Date of admission: 19/12/2019
• Date of examination : 20/12/2019
• Informant: mother

3. History of chief complain
• diarrhea for 1 day
• Vomiting for 1 day

4. History of presenting illness
• Hibak was well until two days before , when she
developed diarrhea for 1 day , acutely onset ,
large amount , more than 10 times a day , rice
watery-like and watery in consistency , bad odor ,
and not contain mucus nor blood, associated
with abdominal cramping.
• Vomiting for 1 day, small amount, 10 times a day,
non projectile, no billous, no aggravating and
relieving factors, and associated with nausea.

5. Systemic Review
• All other systems are un remarkable .

6. PAST MEDICAL HISTORY
• She has previous similar condition 2 years ago
and has been admitted at CUBEYD HOSPITAL for
GIARDIASIS .
• No chronic and congenital heart diseases.
• No blood transfusion .
• No previous operations .
• No history of imaging .
• No history of traveling .
• No known drug allergy .

7. Drug History
No documented past taken drugs .

8. Birth history
A: Ante-natal Care
• The mother was 37 years old at the birth of
Hibak .
• She hasn’t visited MCH routinely during her
pregnancy but completed her TT/td
vaccination previous pregnancies .
• She visited MCH ( hanano) once for sudden
bleeding at two months of the pregnancy .

9. • No supplements taken during pregnancy .
• No bad habits ; smoking or alcohol .
• INTERPETATION : POOR ANTE-NATAL CARE

10. B- natal history
• She was born at hospital for full term ; 40 weeks
with spontaneous vaginal delivery , cephalic
presentation at Medina hospital .
• The membrane rupture was 5 mins before the
labor , duration of the labor was around 1 hour
and placental delivery took around 10 mins .
• The apgar score is unknown.
• No complication during labor
• INTERPRETATION : GOOD NATAL HISTORY

11. C – post-natal history
• Baby cried immediately , pink in color , no
cyanosis , no jaundice , no pallor , no
convulsion and went home with her mother
few hours after delivery.
• Started breastfeeding after 30 minutes as the
mother said .
• Meconium was passed in the first 24 hours .
INTERPRETATION : GOOD POST NATAL HISTORY

12. Feeding history
• Started breast milk and water 30 minutes after birth ,
frequency of breastfeeding was 4 times a day , and
each one for 30 minutes.
• Started weaning after 6 months ; potato , liver ,
vegetables , fruits , pasta and water, 2 times a day and
continuation of breast feeding.
• INTERPRETATION: NO EXCLUSIVE BREASTFEEDING .

13. Immunization history
• She took BCG and OPV 0 at left upper arm and mouth
respectively at 5 days after birth.
• When she was six weeks of age she got OPV 1 and
PENTA 1 orally and anterolateral mid thigh .
• At 10 weeks of age she took OPV 2 and PENTA 2 orally
and anterolateral mid thigh respectively .
• At 14 weeks of age , she took OPV 3 and PENTA 3
orally and anterolateral mid thigh
• At 9 months , she took measles vaccine at right upper
arm.
• She has completed the vaccine at Hanano hospital.
• Interpretation: complete vaccination

14. Growth history
• No previous growth charts

15. Developmental history
• Gross motor: she is able to walk a line and walk a
backward, she can catch a ball, and jump with two feet.
• Fine motor: she can dress her self with a little
assistance , she can turn pages in a book, and can drink
with out assistance.
• Speech , language , and hearing: she understands and
commands, she can say words .
• Social , emotional and behavioral: she smiles , feeds
her self solid foods , drinks from a cup , helps with
tasks like dressing.
• Interpretation: good developmental history

16. Social history
• Home: maternal attitudes is good , father and
mother are separated due to death of her father
for gun shot , so her father is absent.
• Housing: they live in their own house that consist
of two rooms , one kitchen , and one tube , they
do not use net , and no animals in the house.
• The mother is a house wife and the father has
passed away.
• There is no bad habit in the family.

17. Family history
• The age of the mother is 40 years and her
health is good.
• The family income is poor , family size is small
and no bad habit.
• She has eight siblings ( one sister , five
brothers , and two siblings are died)
• No consanguinity.

18. Physical examination
• General condition : patient looks ill , lethargic,
sunken eyes , dry mucus membranes , un able to
drink and feeding , have NG-tube for feeding.
• Interpretation: severe dehydration.
vital signs
On admission on my examination
Temperature: 36.3 c temperature: 36.8 c
Pulse rate: pulse rate: 130 b/m
Respiratory rate: 28 b/m respiratory rate: 25 b/m
Interpretation : Normal vital signs

19. • Skin: skin turgor goes back quickly .
• HEENT : Sunken eyes , other are unremarkable
• Respiratory system
A- Inspection= symmetric of breathing , didn’t
use of accessory muscles for breathing , RR
was 25breath/m
B- Auscultation = equal breath sounds , no
rhonchi , no wheezes , no upper airway noises.

20. • Cardiovascular system
• Extremities: warm as normal .
• Pulse: strong or normal volume , and PR was
130b/m
• No heaves no thrills .
• S1 and s2 are normal and no extra heart
sounds .

21. Abdomen
• Inspection: no scaphoid/ no distended , no
umbilical hernias.
• Palpation: skin turgor backs rapidly , no
hepatosplenomegally, no tenderness , no
guarding and no masses.
• Percussion: no ascites and no fluid thrill
• Auscultation: bowel sounds are present.

22. Mss ,spine , neurological
• Are all un remarkable

23. Anthropometric measurement
• Weight: 13.9 kg
• Height: 100 cm
• Z-score: <-1
• HC: 52cm
• Muac: 13 cm
• WFA: 50th percentile
• HFA: 95th percentile
• Interpretation: Normal according to age .

24. Case summery
• Hibak Abdi Hassan is a 2 years and 8 months old female
whose weight 13.9 kg and a height of 100 cm was
admitted to banadir hospital on 19/12/2019,
complaining of diarrhea for 1 day, acutely onset , large
amount , more than 10 times a day , rice watery ,
watery in consistency , bad odor associated with
abdominal cramping.
• Vomiting for 1 day small amount more than 10 times,
non bilous , no aggravating and relieving factors.
• Her examination : looks ill, lethargic , sunken eyes ,
dry mouth , un able to drink , NG-tube.
• Vital signs: RR: 25 b/m temp: 36.2 c PR: 130 b/m

25. Suspected diagnosis
• Cholera ( vibrio cholera)

26. Differential diagnosis
• Cholera
• Giardiasis
• Amoeba
• Salmonella
• Shigellosis
• E coli

27. investigations
• Stool culture ( confirmed v. cholera 01 or
0139).

28. Management
• Ringer lactate 100ml/kg:
– Phase 1: 417ml for the first one hour
– Phase 2: 973ml for the second five hours
• ORS solution: 1,112ml for four to six hours
• Zink tab 20 mg 1x1
• albendazole tab 400 mg 1x1
• Antibiotic: erythromycin tab 250 mg 1x2

29. Progressive notes
• 21/12/2019 : story: patient was complaining
diarrhea 3 times , large amount yellowish in
color , bad odor and vomiting for 2 times
which is small amount.
• Objective: conscious , alert , sunken eyes ,
dry mouth , normal urine output , v/s: T=
36.2c RR= 26 breath/m
• Assessment: some dehydration
• Plan: continue treatment.

30. Progressive notes
• 22/12/2019 Story: her complain was diarrhea
one time , small loose stools no vomiting
• Objective: conscious , alert , looks ill , no
sunken eyes, no dry mouth , normal pulse
volume , skin pinch goes back rapidly, chest
clear , abdomen soft.
• Assessment: no signs of dehydration
• plan: normal discharge

31. Discharge recommendations
• I gave ORS packets enough for 2 days , at
discharge a long with instructions and how to
prepare ORS solution and advice on when to
seek care.
• I taught the mother on safe hygienic practices
before discharge ( hand washing , safe boiled
water )
• I recommended to mother, give her baby Zinc,
and give extra fluid(water).
• Return, if there is any danger sign.

32. Thanks
any comments and
questions.