PAEDIATRICS CASE PRESENTATION.pptx

Case of nephrotic and nephritic syndrome in children causes and treatment

1. PAEDIATRICS CASE PRESENTATION

2. DEMOGRAPHICS Name : TT Age: 1 year old Sex: Female Address: Mungona village Chief: N yanje D.O.A:15/09/21 D.O.D:22/09/21

3. POPD ADMISSION (15/09/21@11:10hrs) C/O :cough1/12 : fever 1/52 :abdominal distension 6/7 Hxpc : H x of a cough for a month which is productive, associated with difficulties in breathing Has a hx of night sweats and loss of weight Child also has abdominal distension which was associated with vomiting Vomited twice on the day of admission, vomitus was whitish in colour No hx of diarrhoea, and child was opening bowels normally

4. PMHX : this is the 2 nd hospital admission First admission was at Levy M wanawasa T eaching H ospital for similar complaints and was diagnosed with TB and started on ATT (a month) RVT- unknown BIRTH HX : born at term via SVD , BWT 3.6kg,cried immediately after birth. IMMUIZATION HX :up to date. NUTRITIONAL HX : still breast feeding and eats three times a day whatever is available FamHX : there was a P ositive TB contact

5. POPD ADMISSION NOTES ON EXAMINATION Wasted ( Wt for Lt < - 3 SD) Alert but lethargic Af ebrile to touch Not pale , not jaundice , not cyanosis Oral thrush No signs of dehydration RS : C repitations bilaterally CVS :S1S2 regular P/A : Flat , soft, non tender, with hepatomegaly MSS: No edema VITALS Temp: 37 C SPO2: 96% on air Pulse: 113/ min RDT –negative

6. IMP: PTB R/O Treatment Failure with Oral Candiasis in SAM (Wasting type) PLAN FBC LFTS,RFTS Calpol 125mg po qid C efotaxime 300mg tds iv 4 hourly vitals A dmit in M busa C ontinue ATT

7. LAB RESULTS FBC WBC 13.20* 10 3 MCV 79.6 fl HB 10.6 g/ dL MCH 23 pg PLT 269 * 10 3 NEU 6.79 * 10 3 LYM 5.74 * 10 3 MON 0.53* 10 3 Blood Smear ….NO MPS SEEN

8. BIOCHEMISTRY AST 90.1……………….(0.0-35.0) ALT 22.0………………..(0.0-45.0) UREA 3.98…………….(2.80-7.20) CREATININE 49.38……………(71.00-115.00)

9. WARD REVIEW 16/09/21 10:25 F 1 year old Day 1 post admission. Being m anaged for 1 ) SAM 2)PTB 3) oral candidiasis No vomiting ,no diarrhea DCT was done, both mother and child tests reactive, DBS was collected Started ATT ON THE 18/8/21 (3FDC1 TAB AND E 1 TAB ) with good adherence O/E Alert no pale, jaundice ,cyanosis not in respiratory distress

10. Vitals: temp 38.1 C ,spo2 96% ,HR 113bpm ,WT6.1kg hair changes (brownish and light) RS: Bilateral crepitations CVS:S1S2 Regular P/A: Distended with hepatomegaly

11. PLAN CXR Folic acid 5mg OD Mebendazole 500mg PO stat V itamin A 100,000 PO stat N ystatin 100,000 IU QID PO C otrimoxazole 240mg OD PO C ontinue with ATT F -75 65mls 3 hourly Start cART ABC/3TC/ LPVr (mother referred to ART clinic)

12. WARD REVIEW 17/09/21@12:34 HRS M other says no clinical improvement since child started taking ATT. Still coughing No diarrhea , no vomiting C urrently on F75 O /E wasted tachypnoeic febrile to touch mildly pale

13. VITALS: SPO2 43% on air , HR 186, TEMP 38.1 C ,WT 6.09 kg Chest : reduced air entry on the Rt with crepitations bilaterally CXR shows heterogeneous opacities on both R ad L zones with increased cardiac shadow CVS : Gallop rhythm P/A : soft hepatomegaly 4cm below coastal margin MSS: no oedema

14. PLAN ECHO Continue C efotaxime Continue ART, ATT , P yridoxine Continue Septrin , Calpol Continue F 75 Start O2 2L/ min via nasal prongs M onitor saturations M ove to acute bay 17/09/21@ 20:00 Vitals :SPO2 83% on 2L, temp 36.7◦c. The plan was to increase O2 to 5L SPO2 increased to 99 %

15. WARD REVIEW 18/09/21@08:55 PTB with Oral Candiasis in SAM Temp spiking 38.1c No diarrhea no vomiting Having low saturations SPO 2 68% on O2 O/E I rritable I n respiratory distress Afebrile to touch Chest: reduced air entry on the right side with crepitations bilaterally CVS: S1S2 t achycardic P/A : distended ,soft ,hepatomegaly

16. PLAN C ontinue ABX C ontinue ART,ATT RUFT 2 and half sachet/day F-75 130mls 4 hourly D aily wts C ontinue O2 at 5l and monitor SPO2

17. WARD REVIEW 19/09/21@07:40 PTB with Oral Candiasis in SAM Child still coughing Temperature has come down VITALS:SPO2 95 % on 5L O2, HR 113bpm,TEMP 36.9C PLAN 1)Stop nystatin 2)Fluconazole 50mg OD IV 3)Continue ATT,ART,ABX 4) Continue O2 5) Continue F 75

18. WARD REVIEW 20/09/21 10:00 1 yr old being treated for PTB with Oral Candiasis in SAM T emp has come down No vomiting ,no diarrhea On C efotaxime , Fluconazole , S eptrin O/E Asleep In respiratory distress Subcoastal and intercoastal recession Tachypnoeic SPO2 99%, TEMP 37.2C,WT 5.89kg Chest: bilateral crepitations CVS: S1S2 Regular P/A soft

19. PLAN Stop F 75 S tart f 100 130 mls 4 hourly C ontinue ABX , and S eptrin C ontinue ATT , ART Keep on O2

20. WARD REVIEW 21/09/21 13:10 Child is lossing weights Admission wt 5.9kg Current wt 5.7kg On C alpol , C efotaxime,F /A , and Fluconazole O/E In respiratory distress with marked subcoastal and intercoastal recessions On O2 5l/min SPO2 87% Chest: bilateral crepitations CVS:S1S2 regular , tachycardiac with gallop rhythm and murmur in 2 nd intercoastal space

21. PLAN C lose Cefotaxime C ontinue ATT, ART, Fluconazole Fu rosemide 10mg OD IV Continue O 2 ECHO when child is stable

22. 22/09/21@ 03:30hrs Called to review pt Child had started gasping O/E P upils were fixed and dilated N o cardio – pulmonary activity Certified dead CAUSE OF DEATH:PULMONARY TUBERCULOSIS WITH SAM IN RVD