Paeds Attachment Week 2

1) 4 y/o little girl, brought in to the hospital late at night, was sent directly to the high dependency unit as she had high random blood glusoce of 21/22/23 mmol/dL overnight. She was complainig of polydipsa, polyuria and nocturia. she had one episode of projectile vomiting prior to admission. blood gases was done on admission and she was found to be acidotic. glucose and ketones were found in her urine. a diagnosis of diabetic ketoacidosis was made by the night staffs. Insulin and IV fluid were given to try to bring down her blood sugar level and correct her acid-base balance. During the ward round in the morning, the little girl looked very alert but a random blood test was done and her level was still as high as 18mmol/dL. it was still consider diabetic even she just had her breakfast. a diabetic nurse was arranged to see the parents to educate them on insulin injection. however on the second night of admission, her random blood sugar went down to 2mmol/dL. it might be due to insulin over dosage. she was given a chocolate bar at night by a junior doctor and the blood glucose level went high up again. the next morning, when they discussed the case with the consultant, he said that giving chocolate was not a good choice. instead, we shall just monitor the patient. if there's no severe problems caused by the hypoglycaemic level, the correct thing to do is adjust the next dosage of insulin instead of giving glucose. this girl was then discharged from the hospital with an appropriate dosage of insulin injection. but the follow-up system in this country is very good as the diabetic nurse will go to her house to make sure that her mum is able to give her insulin as required.
2) 5y/o girl complaint of intermittent abdominal pain in the morning in the past 1 week. the parents thought that it might be an excuse for their child refused to go to school. however, this girl was in pain this early morning at 5am, pressing on the tummy and squatting down. the parents started to take this seriously as this wasnt the usual time for her to wake up and they knew she was in real pain. they brought her to the hospital and the consultant reviewed her later in the ward round. blood test that was done on admission showed a raised amylase level of 1320 but with CRP<3. style="color: rgb(255, 0, 0);">infective pancreatitis as a result of viral or bacterial infection. she was given a course of antibiotics and pain killer for symptomatic treatment. the pain was subsided on the fifth day after admission and this girl was discharged as she was back to her normal self. however, the consultant would like to review her in his clinic after 2months as he was the paeds gastroenterologist.
3) 21d/o baby girl came in with post feeding apnea. the registra who clerked her witness the episode of her going blue/cyanosed after breast feeding. according to him, it happened just few minutes after he took the histrory and the baby's face just went blue and she was crying. this baby was a preterm, normal spontaneous delivery at 36 weeks of gestational age and with the history of polyhydramnion. her absent of breathing after feeding was thought to be cause by infection. full septic screen was done, which involved the blood test, lumbar puncture/CSF test, urinalysis and chest x ray. none was contributory. the consultant picked up a murmur and she had an echocardiogram done and only 2 branches were found from the aortic arch. it could be normal in some people to have the third branch coming out from any of the two branches. so there wasn't much concern on it as the perfusion on her upper and lower part are normal. a video-fluroscopy was done in the following week to look at the velopharyngeal closure as the consultant suspected she was having tracheo-oesophgeal fistula. the result showed traces of aspiration and the second video fluoroscopy was arranged in 2 weeks time as there wasnt enough evidence to suggest tracheo-oesophgeal fistula. because of her poor feeding, she was put on NG feeding and she was very stable and tolerating very well with her feed. the parents were educated on NG feeding and this baby girl was discharged home with the NG tube as there wasnt any other issues once her feeding was settled. she was still awaiting her second video fluoroscopy.