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- Heather Lesage-Horton, MD*
- Gina Ney, MD, PhD*
- Jennifer Stojan, MD*
- *Department of Pediatrics, University of Michigan, Ann Arbor, MI.
AUTHOR DISCLOSURE
Drs Lesage-Horton, Ney, and Stojan have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Case Presentation
A 21-month-old girl with asthma and eczema (treated by albuterol and topical hydrocortisone as needed) presents in January with 5 days of cough, rhinorrhea, and fever. One day before presentation, she developed emesis and diarrhea with a decrease in oral intake and urine output.
On presentation, her temperature is 101.7ºF (38.7ºC), with a respiratory rate of 60 breaths per minute, a pulse of 160 beats per minute, blood pressure of 110/68 mm Hg, and an oxygen saturation of 91% on room air. Mucous membranes are dry, and capillary refill is delayed. She is responsive but in moderate respiratory distress with intercostal and subcostal retractions. Crackles and coarse breath sounds are auscultated bilaterally. She has abdominal distension with significant right upper quadrant tenderness and guarding.
Laboratory results are remarkable for a blood glucose level of 40 mg/dL (2.2 mmol/L), venous pH 7.15, lactate level of 73.9 mg/dL (8.2 mmol/L), bicarbonate level of 16 mEq/L (16 mmol/L) with an anion gap of 17 mEq/L (17 mmol/L), aspartate aminotransaminase (AST) level of 789 IU/L, and alanine aminotransaminase (ALT) of 301 IU/L. Resuscitation with 25% dextrose achieved normal blood glucose levels, and further fluid resuscitation with 2 normal saline boluses followed by 5% dextrose and 0.45% normal saline was administered. Her total bilirubin level is 1.0 mg/dL (17.1 μmol/L) with an alkaline phosphatase level of 271 IU/L. Serum albumin, protein, …
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