Case presentation

Case presentation

Huda Al-ShibliE.M.R1

Outline;

Case presentation Discussiontake home massages

4 yr-old child2 day-h/o abdominal pain, loose motion and vomiting

Enter your title here

This is a dummy text. Please ignore the following content as it is dummy text .

This is definitely some dummy text .

The text here is meaningless as it is used to fill this slide .

Enter your title here

This is a dummy text. Please ignore the following content as it is dummy text .

This is definitely some dummy text .

The text here is meaningless as it is used to fill this slide .

Enter your title here

History 1 survey

2 survey

DDx Investigations

Rx

Disposition

1 survey

A: patentB: normal, RR 35, sPO2 97% in RA,

C: P 110, BP 100/84, T 37.0 cD: GCS; 15/15, pupils 2 mm reacting b/l ,

E: NADWt : 13 kg

What do you want to do?

History

Abdominal pain X 2 daysassociated with vomiting 5 times /day , small to moderate amount , non

projectile, Loose motion 5 times /day , small amount semisolid , no blood or mucous Child is less active , not feeding well

h/o cough and cold during the last week and now improvedNo h/o fever

No past h/o medical problem

2 survey

O/E: Small boy , looks unwell, tachypnic , but alert and responding

Not jaundiced or paleDry mucous membrane Capillary refilling 3 sec

ears : clearThroat : mild congestion and mild enlarged tonsilsChest ….. Clear

CVS …… S1+S2, no gallop, no murmur Abdomen: soft with ?epigastric tenderness, BS +ve, no hepto-splenomegaly CNS :no neurologic deficit, no meningeal signs.

What is your impression?What is your next step?

Impression : gastroenteritis with moderate dehydration ( 5-7%) Plan:

Blood investigations: cbc, ue1IVF 20 ml /kg NS bolus , then dextrose saline 0.45 % @100 ml/hr + kcl 10 mmol/500 ml

To give ondasterone and try oral intake Reassess later

Reassessment

After 1 hour: The child looks unwellNot active , but still alert and responding

RR 37Capillary refilling 3 sec

The mother said he is drinking good amount of water but he vomited 3 times and had one

small amount of loose stool .

Investigations

Lab: CbcHb : 12WCC: 12UE1

130:Na K: 4.0

13:Hco3Urea and creatinine :WNL

It was the end of the shift The case handed over to the next coming teamAfter reassessment , they sent VBG and showed pH of 7.2 and they check reflow it was 16 mmol/l So it was DKA and they started management

DKA

DKA is the leading cause of morbidity and mortality in children with T1DM ranging from 0.15 % to 0.31 . %

In addition, DKA also can occur in children with T 2 DM; this presentation is most common among

youth of African-American descent .

DEFINITION 

 Consensus statements from the European Society for Paediatric Endocrinology/Lawson Wilkins Pediatric Endocrine Society in 2004, the American Diabetes Association in 2006, and the International Society for Pediatric and Adolescent Diabetes in 2007 defined the

following biochemical criteria for the diagnosis of DKA: 1-Hyperglycemia, defined as a blood glucose of >200

mg/dL (11 mmol/L) AND 2-Metabolic acidosis, defined as a venous pH <7.3 and/or

3-a plasma bicarbonate <15 meq/L (15 mmol/L)

Take home messages

1-Not every loose motion and vomiting is a GE .2-If a dehydrated child not responded to fluid

therapy , and it is unlikely to be sepsis , ask yourself : is it a DKA?

3-check reflow for pt with ketone positive in the urine .