Pediatrics in Review
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(Pediatrics in Review. 2000;21:205-209. doi:10.1542/10.1542/pir.21-6-205)
© 2000 American Academy of Pediatrics
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Index of Suspicion




   Case 1 Presentation
 
A 16-month-old girl arrives at the emergency department unconscious. Over the past few hours, she had become increasingly clumsy and then sleepy. On the way to the emergency department, she had a brief episode of eye rolling and produced a large mucous stool, then became limp. No family members have been ill, and her parents report no ingestions or fever. Shortly after arrival, she experiences a generalized tonic-clonic seizure that lasts 30 minutes and ceases after administration of intravenous diazepam and phenytoin.

On physical examination, the child is comatose. Her temperature is normal, pulse is 135 beats/min, and respiratory rate is 50 breaths/min. Her pupils are 3 mm in diameter and respond sluggishly to light. There are no signs of head injury, her neck is supple, and the tympanic membranes and fundi appear normal. Copious bloody secretions are suctioned from her nose and mouth. Respirations are deep and noisy, with scattered rhonchi audible. Cardiac examination reveals tachycardia in what appears to be a normal rhythm. The abdomen is soft and nontender, with no palpable masses or organs and active bowel sounds. There is no skin rash.

The child passes a large, bloody stool and resumes seizure activity, developing severe respiratory distress that requires endotracheal intubation. Intravenous phenobarbital and midazolam are administered to control the seizures. She has a blood glucose level of 18.5 mmol/L (333 mg/dL). A complete blood count; determinations of sodium, potassium, calcium, magnesium, and ammonia levels; cerebrospinal fluid analysis; urine dipstick and toxicology testing; and computed tomography of the head all yield normal results. Three hours after arrival, still receiving mechanical ventilation and oxygen, her Glasgow Coma Score is 3 and blood pressure is 114/89 mm Hg.


   Case 2 Presentation
 
A 1-year-old boy has had a high spiking fever, progressive abdominal distension, and diarrhea containing blood. He had Salmonella gastroenteritis . . . [Full Text of this Article]


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Rapid Responses:

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Immunodefficiency with hypergammaglobulinemia
michael rotstein
Pediatrics in Review Online, 31 May 2001 [Full text]

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