What is your first choice of diagnosis and management?
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Prepared by...
Virat Sirisanthana, M.D. |
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Department of Pediatrics,
Chiang Mai University
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| Chief Complaint
and Present Illness: A 2-month-old female infant had a 7-day
history of subacute onset of difficulty in breathing. She was born in the
community hospital without any complication. Her birth weight was 3350 grams.
She had been healthy until this illness. Her mother denied any history of
fever. At the community hospital she had respiratory distress so she was intubated and refered to our hospital with intravenous penicillin G. |
| Family History : was not available at the time of admission |
| Physical examination: |
| GA: BW: 4050 grams,
was intubated, not pale, no jaundice VS: T= 38.4 C (max), RR= 60/min, P = 160/min, Anterior fontanelle 1.5 x 1.5 cm., not bulging Lung: she was on respirator Abdomen: liver 2 cm below RCM , spleen 2 cm below LCM. |
| Laboratory Findings: |
| Complete blood count: Hemoglobin
9.3 g/dl, hematocrit 29 % , platelets 174,000, WBC 18,500, differential: 62 % polys , 38 % lymphocytes. Electrolyte: Na 131 , K 3.8 , Cl 106 , CO2 22 mEq/L, BUN 9 mg% , Cr 0.4 mg% Chest radiograph: (see below). |
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Click to see larger CXR |
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What is your first choice of diagnosis and management? |
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| Further course of illness......... Click here | |