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What Does This Blood Test Report Indicate?

Posted on Thu, 16 Jun 2016

Question: ++
We consulted a different paediatric and he changed the antibiotics.
She has then given with Levofloaxacin+Ornidazol and Paracetamol 125mg+ mefnac acid for 3 days.
Fever went worst now and raised to 104+105F with stomach pain. Then as per Dr. advise we did following test.
MP(ICT), Hemoglobin, TLC, WBC, Typhoid.
Then she given Momocef O 100, Levofloaxacin, Dortin DS, P-250 & Serax Forte. This has been given 2doases now except P-250 which is being given in every 4-5 hrs. due to rise in temp.

please advise what to do?
How to control the high fever.
I am attaching the blood test report.

Thanks
XXXX

Answered by Dr. Sumanth Amperayani (1 hour later)

Brief Answer:
need more information

Detailed Answer:
Hi....

1. How many days of fever?
2. What are the other symptoms apart from fever?
3. Is there any loose motions and vomiting?
4. Was blood culture done before starting antibiotics?
5. Can you upload any blood test reports if they were done?

Please get back to me with answers so that I can guide you through better.

Regards - Dr. Sumanth

Above answer was peer-reviewed by : Dr. Naveen Kumar

Follow up: Dr. Sumanth Amperayani (1 hour later)

Sorry it was additional information for Mr. XXXXXXX XXXXXXX with my reply, but unfortunately it posted as a separate thread. You can get all info from my other post to Dr. XXXXXXX

It would be good to add all these info that too.

Thanks,
XXXX

Answered by Dr. Sumanth Amperayani (6 hours later)

Brief Answer:
I have a few questions for you - please upload Ultrasound report too

Detailed Answer:
Hi... I have gone through the details which you have provided for Dr. XXXXXXX XXXXXXX

My opinion on this as of now -

1.The child's fever is now more than 7 days and still running high.

2. Pain abdomen is still there due to enlargement of liver and spleen due to any type of infection either viral or bacterial. Fever going on for so long with such high intensity could not just like as viral illness.

3. You have uploaded the image of the test - but differential count is lacking in it. Only total count is depicted. I need differential count too.

4. Widal test has been done as a slide method and this is very very unreliable. Moreover Widal test not to be ordered unless it is more than 7th day of illness.

5. You have used 3 antibiotics and Mefenamic acid too.

I have a few questions for you. Please do not think that I am again and again for more information. I am doing this in the best interest of the kid -

1. In-between two fever episodes how is the child's activity?
2. Has any blood culture been done before using 3 antibiotics?
3. Can you upload the ultrasound abdomen report here?

My suggestions if kid is still running high fever like 104F -

1. Hospitalize the kid.
2. I feel it is enteric fever or typhoid which is partially treated.
3. He may require Intravenous antibiotics like Ceftriaxone.
4. I would like to do the following tests before strating IV antibiotics - CBC including differential count/ WIDAL TEST BY TUBE METHOD/ Chest X-ray/ Blood culture/ urine routine and urine culture.

Coming to your query about how to reduce the fever -

Paracetamol can be given in the dose of 15mg/kg/dose (maximum ceiling dose of 500mg) every 4-6th hourly that too only if fever is more than 100F.

I suggest not using combination medicines for fever, especially with Paracetamol.

MEFTAL-P CONTAINS MEFENAMIC ACID WHICH IS A NSAID. IT CARRIES THE RISK OF GASTRITIS AND RENAL PROBLEMS IN THE LONG RUN. PLEASE DO NOT USE MEFTAL-P or any other combination containing Mefenamic acid.

I have published in a reputed medical journal in XXXXXXX about why Mefenamic acid should not be used in children. i am sending the link to it.

https://www.google.co.in/?gfe_rd=cr&ei=db8mV73LN-WK8QesrayoCw&gws_rd=ssl#q=sumanth+and+mefenamic+acid

Hope my answer was helpful for you. I am happy to help any time. Further clarifications and consultations on Health care magic are welcome. Wish your kid good health.

Dr. Sumanth MBBS., DCH., DNB (Paed).,

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Sumanth Amperayani (1 hour later)

Thank you much Dr. to looking into the case and abstract all info.
I can understand your concern and I never mind to provide you as much as info I have.
Answer to your 3 questions:
1. Child is active most of the times, but she becomes inactive and less responding when fever goes to high like 104-105F.
2. She has never advised by Paediatrician or never gone through any Blood culture yet.
3. USG abdomen will be done in an hour or so, after that I will upload the result.

Current Observations:
1. Paracetamol 250mg dose of 5ml given 5hrs before and then temperature is seems to be down to normal now.
2. Two doses of Monocef O 100 has been given yet.

Thanks,
XXXX

Answered by Dr. Sumanth Amperayani (3 hours later)

Brief Answer:
These are my suggestions - thank you for the information

Detailed Answer:
Hi...thank you for understanding and getting back with the required information.

I am changing the order of my preferences after going through the information you have provided.

My suggestions -

1. As you say the kid is active in-between 2 fever episodes - You can wait for another 48 hours before getting the child hospitalized.

2. You can give only Taxim-O (Cefixime) as the antibiotic at 20mg/kg/day in 2 divided doses for a total of 14 days. If you can get back to me with the weight of the kid I will suggest you the appropriate dose that you need to give.

3. If in 48 hours the fever doesn't settle then the child will require hospitalization and further follow up. if you are getting her hospitalized, then - do the following tests before starting IV antibiotics - CBC including differential count/ WIDAL TEST BY TUBE METHOD/ Chest X-ray/ Blood culture/ urine routine and urine culture.

4. If hospitalized the antibiotic of choice will be Intravenous Ceftriaxone.

BUT HOPEFULLY SHE WILL NOT REQUIRE HOSPITALIZATION.

I wish your kid a speedy recovery. If you need any future medical consultation and suggestions, I will be glad to help. You can approach me at the following link. Please find the link below -

www.healthcaremagic.com/doctors/dr-sumanth-amperayani/67696

Above answer was peer-reviewed by : Dr. Sonia Raina

Follow up: Dr. Sumanth Amperayani (7 hours later)

Hi Dr.
please find attached the test reports.
now the fever seems to be controlled, but stomach pain is still there. the last time fever measure was before 6 hrs. and it was around 100-101F.
She has given with 3 does of Monocef O and Levofloaxacin till time.
Please advise.

Thanks,
XXXX

Answered by Dr. Sumanth Amperayani (54 minutes later)

Brief Answer:
Stop Levofloxacin....Continue only Cefixime

Detailed Answer:
Hi....all the reports are normal. Don't worry. Looks like a viral illness or typhoid.

Stop Levofloxacin. Give only Monocef-O or Cefixime....no need to give 2 antibiotics.

Please get back with weight of the child so that I can suggest you the appropriate dose of Cefixime or Monocef-O.

Regards - Dr. Sumanth

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sumanth Amperayani (4 minutes later)

Thanks Dr.
Her weight is around 20kg and she is 4.4 years old.
Taxim O is better or Monocef O?
What power of the medicine and how many times are recommended?

Thanks,
XXXX

Answered by Dr. Sumanth Amperayani (2 hours later)

Brief Answer:
Suggestions on medication

Detailed Answer:
Hi...I prefer giving Tablet Taxim-O 200mg 1 tablet twice a day, for a total of 14 days.

Powder the tablet and give it please.

I wish your kid a speedy recovery. If you need any future medical consultation and suggestions, I will be glad to help. You can approach me at the following link.

Once the page opens there will be an option below my image as – ASK ME A QUESTION – click on it.

Please find the link below -

www.healthcaremagic.com/doctors/dr-sumanth-amperayani/67696

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sumanth Amperayani (34 minutes later)

Does that means Taxim O 200+200 daily for 14 days and no other medicines?

Answered by Dr. Sumanth Amperayani (1 hour later)

Brief Answer:
Yes please... That is what I meant

Detailed Answer:
Hi...yes please... that is what I meant.

The dose is 20mg/kg/day...in 2 divided doses, for a total of 14 days.

Regards - Dr. Sumanth

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar

Follow up: Dr. Sumanth Amperayani (2 days later)

Thanks dr. she is recovering now. But the little bit stomach pain is still there.

Answered by Dr. Sumanth Amperayani (9 hours later)

Brief Answer:
Stomach pain will be there for a week or two - don't worry

Detailed Answer:
Hi.... this type of stomach pain is quite common in recovering Typhoid fever. It might be there for one or two weeks. Please do not worry about it and there is no need to give any medication for it.

Regards - Dr. Sumanth

Note: For further queries related to your child health, Talk to a Pediatrician. Click here to Book a Consultation.

Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar