hello Dr, this is the case of a 1y5m baby girl admitted to the icp for decreased appetite and diarrhea of 2 months duration and generalized edema of 1 week duration.
this girl is a product of a nvd, full term pregnancy of a g1p1a0 20year old mother.
at 15 months, the patient was admitted to the er for diarrhea, vomiting and fever. she was diagnosed to have febrile GE and was treated by IM antibiotic (Ceftriaxone). vomiting and fever subsided but diarrhea persisted for about 1 week. (Note that the patient's diet was limited to exclusive breastfeeding). her pediatrician ordered to stop breast milk and star solid food introduction.(he thought diarrhea was due to BM ???)
As a result to sudden weaning, the child's po intake decreased (according to the mother, the girl only accepted to eat potatoe chips - less than 1 small bag- ,noodles -only water and spices without noodles itself- and juice!!!). Also, her urine output decreased to 1-2 times/day.
20 days later, the child was admitted to the hospital for fever. she was diagnosed to have tonsillitis and was treated by amoxicillin-clavulanate for 1 week. 2 weeks later, she was also admitted for fever and tonsillitis and otitis media and was given 2nd generation cephalosporine and flagyl.
1 week later, the patient was admitted to the hospital for pallor, decreased po intake, decreased urine output, decreased activity. She was given iv infusion. this resulted in swelling of her upper and lower limbs. 2 days later, the parents discharged their daughter.
1 week later i.e 3 days ago, she was admitted in another hospital to the icn for generalized swelling of the entire body.
at the 1st day of admission,the patient is irritative, crying with NO tears, pale. she showed marked edema, generalized, non pitting. cbc showed that she was severely dehydrated. u/s abdomen shows micro lithiasis in gall bladder. at the 2nd day of admission, the patient 's edema was slightly decreased, but it became pitting edema. her SGOT and SGPT increased respectively from 800 and 100 in the 1st day of admission to 4000 and 2200 in 3rd day of admission.