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Infant diagnosed with bronchiolitis, leukocytosis, low CO2 level, lab tests done. What does it indicate?

I appreciate any and all help. My daughter was born in June and all was well. She was a few weeks early and we had a few complications. Fast forward to one month and we noticed her doing a few things that we don t remember my other two girls doing. We recorded it and wrote it down. Fast forward to Thanksgiving. My daughter was almost 5 months and the whole family came down with the flu . She had a 104 fever which lasted two days and was very lethargic. During this time, I thought she had a seizure as I was holding her. The next week I took her to the dr and they said she had bronchiolitis . I was told if she developed a fever to bring her back. A week later she did and we landed right back in the dr office. Once again, we were sent home. I gave her breathing treatments and this time her fever remained 104 for 3 days. On day 3 I took her to the emergency room and we were dxed with double ear infections and given 10 days amoxicillin . On day 11 I once again returned to pediatrician and was told daughter had one ear infection remaining and was still suffering from bronchiolitis. To continue treating at home. We pursued the possibility of seizures and went to a neurologist . They wanted a full work up. So we scheduled MRI and bloodwork. At this point we had been on 15 days of antibiotic. We went for MRI and the MRI was refused due to a low pulse ox when sleeping. My daughter was running 89-92 and sent home. The MRI dr came in and listened to her, he said it sounded like she had bronchiolitis and if not better in a few days to return to the children s hospital. he also mentioned something about a heart condition that can cause fluid in the lungs. We went home and waited. Then the beginning lab results came in from her bloodwork. her WBC was 25.8 RBC 4.23 Hemoglobin 10.8 Hematocrit 32.5 MCV 77 MCH 25.5 MCHC 33.2 RDW 13.9 Platelets 467 Neutrophils 40 Lymphs 50 (atypical lymphocytes) Monocytes 10 EOS 0 Basos 0 Neutrophils (Absolute) 10.4 Lymps (absolute) 12.5 Monocytes (absolute) 2.6 EOS (absolute) 0.1 Baso (absolute) 0.1 Immature granulocytes 0 Immature grans (ABS) 0 Let me add we have seen her turning blue around her mouth as well as her extremities going blue/purple. She cannot eat a whole bottle without falling asleep and eating takes her a couple of hours. We returned to the children s hospital a few days later as she was not better and her WBC was still 24. We were dxed wtih bronchiolitis and leukocytosis and told to retest her blood in a few days. Any advice or suggestions would be greatly appreciated. My daughter ahs been sick for over 6 weeks. Is there anything concerning in these numbers our pediatrician does not seem to concerned. I was also informed her carbon dioxide level was 19%. What does this mean?
Asked On : Sun, 30 Dec 2012
Answers:  1 Views:  129
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Neurologist 's  Response
Nov 2013

Thank you for posting your query.

You have provided an excellent and detailed description of your daughter's illness.

Based on the information, she is suffering from a respiratory infection, most likely a bronchiolitis, causing fever, breathing difficulty and feeding problems. She would need to continue the course of antibiotics for full recovery. Low oxygen saturation and feeding problems can be explained by this illness. blue extremities (peripheral cyanosis) could occur if she has breathing problems and can not inhale or exhale properly.

In addition, we need to exclude a cardiac problem, such as right to left shunts, as they could cause cyanosis and make a child prone to get infections. An echocardiography would help.

Seizures can occur with high fever (febrile seizures) and if her MRI and EEG are normal, no anti epileptic drugs would be required.

Best wishes,
Dr Sudhir Kumar MD DM (Neurology)
Senior Consultant Neurologist
Answered: Sun, 8 Sep 2013
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