This article requires a subscription to view the full text. If you have a subscription you may use the login form below to view the article. Access to this article can also be purchased.
Frequently Used Abbreviations
- ALT:
- alanine aminotransferase •
- AST:
- aspartate aminotransferase •
- BUN:
- blood urea nitrogen •
- CBC:
- complete blood count •
- CNS:
- central nervous system •
- CSF:
- cerebrospinal fluid •
- CT:
- computed tomography •
- ECG:
- electrocardiography •
- ED:
- emergency department •
- EEG:
- electroencephalography •
- ESR:
- erythrocyte sedimentation rate •
- GI:
- gastrointestinal •
- GU:
- genitourinary •
- Hct:
- hematocrit •
- Hgb:
- hemoglobin •
- MRI:
- magnetic resonance imaging •
- WBC:
- white blood cell
Case 1 Presentation
A 6-year-old boy complains of leg pain during times of inactivity. The pain is diffuse, affects both legs simultaneously, and feels like “pins and needles.” The episodes occur intermittently throughout the day and are more intense at night, preventing sleep. In the last week, the discomfort has occurred during sleep, waking him. Massage and movement usually bring relief, with occasional need for acetaminophen.
The episodes began 1 year ago, happened one to two times per month, and now occur several times per week and are more intense. He is noted to be “squirming” while sitting still. His past medical history is free of significant illness, including trauma or sleep disturbances. He is an excellent student. Two aunts suffer from chronic leg pain and associated sleep disturbance.
Physical findings are normal. His legs show no muscle abnormalities, redness, swelling, masses, or pain on palpation. Radiographs of the legs are normal. He has a normal WBC count but has anemia (Hgb 10.4 g/dL [104 g/L]) and iron deficiency (serum ferritin, 40 mcg/L). Red blood cell indices reveal a mean corpuscular volume of 76 fL and mean corpuscular Hgb of 26.4 pg. Antinuclear antibody is negative, and erythrocyte sedimentation rate is 1 mm/h.
Case 2 Presentation
A 2-year-old girl is brought to the ED for sudden loss of consciousness. She has had fever for 2 days, with sore throat, nasal discharge, cough, and decreased activity. She had a patent ductus arteriosus closed 1 month ago using a catheter closure device, after which she developed hypertension and was started empirically on propranolol.
Examination reveals an unresponsive child who is breathing shallowly, has a temperature of 101.1°F (38.4°C), heart rate of 164 beats/min, respirations of 40 breaths/min, blood pressure of 170/109 mm Hg, and oxygen saturation of 100% on blow-by oxygen. She has strong peripheral …
Individual Login
Institutional Login
You may be able to gain access using your login credentials for your institution. Contact your librarian or administrator if you do not have a username and password.
Log in through your institution
Purchase access
In this issue
Jump to section
Related Articles
Cited By...
- No citing articles found.