Page 161 - Abstract Book KONIKA 18

Emergency & Pediatric Intensive Care

P-EPIC-003
Venomous Snake Bite in Children: A Case Report

Ernie Yantho, Dewi Ratih, Yusrina Istanti, Moh Supriatna
Department of Child Health, Faculty of Medicine Universitas Diponegoro/Dr. Kariadi General Hospital,
Semarang, Central Java, Indonesia
Abstract
Background Snakebite envenoming has been categorized as one of the neglected tropical disease in many
tropical countries including Indonesia. In pediatric population there was still no standardized guideline
of snakebite management as it was tailored individually based on clinical profile and snake species.
Objective To demonstrate the clinical course and management of snakebite envenoming. Case A three years
old girl was referred to our hospital with diagnosis of snakebite. She was referred with altered consciousness
and history of returned of spontaneous circulation after cardiopulmonary resuscitation. At previous hospital,
she had been given total 6 vials of antivenom infusion. After 48 hours, swelling of left arm extended to left
thoracoabdominal area without bleeding and signs of compartment syndrome¬. Laboratory tests result were
normocytic normochromic anemia (hemoglobin 9.7), leukocytosis (22.800), thrombocytopenia (16.000),
high d-dimer (22.090), low fibrinogen (86) and hyponatremia (119). She was diagnosed with snakebite
envenoming grade 3 with DIC score 7. She was given antivenom 6 vials every 12 hours with supportive
therapies (antibiotic prophylaxis, low dose corticosteroid and platelet transfusion). Swelling had progressed
rapidly so antivenom dose was increased to 8 vials every 12 hours. On day 3 admission, swelling had reduced
with DIC score decreased to 3 then antivenom was tapered off. Total additional 24 ampoules of antivenom
were administered to this patient. Conclusion Early optimal antivenom administration seemed to improve
clinical course and reduce complication of snakebite envenoming. We recommend antivenom administration
dose tailored based on clinical profile.
Keywords: snakebites; envenoming; antivenom

P-EPIC-004
Clinical Characteristics and Outcomes of Pediatric Severe COVID-19
at Mohammad Hoesin General Hospital Palembang

Nurmega Kurnia Saputri, Indra Saputra, Desti Handayani, Silvia Triratna
Department of Child Health, Faculty of Medicine Universitas Sriwijaya/Dr. Mohammad Hoesin General Hospital,
Palembang, South Sumatera, Indonesia

Abstract
Background Data on severe COVID-19 in the pediatric population remains limited. Early diagnosis of
COVID-19 is difficult due to various clinical manifestations and commonly resemble other diseases.
Differences in patient characteristics among places may associate with the outcome. Objective To identify
the clinical characteristics and outcome of children with severe COVID-19 at PICU Mohammad Hoesin
General Hospital Palembang. Methods The medical records of 40 patients with suspected severe COVID-19
since June 2020 until June 2021 were reviewed. Inclusion criteria were children one month until 18
years old, suspected COVID-19 based on clinical manifestations, laboratory and radiologic findings.
Results Fourteen of 40 patients with positive PCR nasal swab had median (range) age 2(1-5) years old,
and 10/14 were male. On admission, 14/14 had shortness of breath, flu-like symptom 8/14, decreased
consciousness 8/14, fever 6/14 and seizure 3/14. Laboratory results showed an increase of C-reactive
protein (CRP) in 10/14 patients, leukocytosis 6/14, leukopenia 1/14 and lymphopenia 1/14. Pneumonia
was demonstrated on 13/14 chest radiographs. Comorbidity findings were neurological disease 8/14, lung
tuberculosis 2/14, autoimmune disease 1/14 and malignancy 1/14. Mechanical ventilation was used in 9/14,
and non-invasive ventilation was in 5/14 patients. After completing the follow-up period, 9/14 patients
with comorbid factors died, and seven required mechanical ventilation. Conclusion Severe COVID-19 was
found predominantly in male, with sign shortness of breath on admission, increasing CRP, pneumonia on
radiograph, and mortality increased with comorbid factors.
Keywords: severe COVID-19; pediatric; ICU

KONIKA XVIII Abstract Book 113