Paeds Attachment Week 4

1) 11y/o boy came in yesterday with the complaint of red itchy urticaric rash, initially on the knee joint and ankle joint, now spreading to the chest, neck and the back. the rash appeared on his right knee and right ankle on the weekend, after playing in the woods. he developed joint pain and swollen knee and ankle the next day, he was referred to the hospital by the GP after that. according to the mum, this boy had taken a course of antibiotic for one week prior to admission. but it was unlikely to be an anaphylatic reaction after completing one week of antibiotic treatment. this boy didnt have any allergic history and his diet was the same as usual. it was unlikely to cause by food as well. patient's mother claimed that the pattern and location of his rash were changing, but was much better after taking piriton(anthistamine). the registra beleived that it might be an allergic reaction caused by a new kitten that was taken home one week ago. as mum was saying that her nose was allergic to the kitten, and therefore she sent the kitten away. but the problem with allergies is it is hard to find out what the allergen is, unless there is a second allergic reaction. and anything common in the 2 reactions that comes in contact with the patient would likely to be the cause. so the only management is avoidance of any possible allergen to prevent it from happening again.
2) 3m/o baby girl came in with vomiting since birth on week1 of my attachment. initially she was sent for ultrasound scan and barium follow through, and the results came back to be normal. they tried on other milk for her as the consultant thought it might be cow's milk intolerance. at the same time, she was given ranitidine because the consultant thought she's reflux as whenever the mum reported her vomit, it was just a little bit of water. she was taking her feed normally after that and was discharged at the end of week2 with the diagnosis of reflux. however, the baby came back on the weekend with the similar complaint. the consultant started to be suspicious as no one had ever witnessed the vomit before, the vomits were all claimed by the mum and the mum was known to have postnatal depression. on week3, mum sent in a pinky urine to the nurse and everyone started to worry of her having haematuria/urinary tract infection. the urine was sent to for microscopy and no red cells was found. the paeds trainee requested them to keep the urine but the microbiology lab refused to do so as they said that the pink colour was most likely due to dye. the urine sample was then sent to the biochemistry lab and they agreed to keep the urine sample for further investigations. however, the next urine specimen was clear and normal. as a result, it was not likely for this baby to have UTI. at the end of week3, her vomit was settled and she was sent back home again. BUT...... she came in again on week4... SWEAT AH!!! with complaint of diarrhoea and vomit. this time the stool sample was sent for culture and the result came back to be positive for Clostridium difficile. Oh My God!!! she finally picked up something more serious than her original sickness due to prolonged admission in the hospital. she's now treated with metronidazole. her father finally appeared in this admission. coz all the while, i only see the grandma and the mummy. i could see that her mum was interacting better as compared to the first admission. the parents now show more concern on the baby. i hope she would get well soon.
3)1y/o boy was sent to another hospital for repair of tetralogy of fallot on my week 1 of admission. the first time i saw him, he was very stable and didnt not show the squatting position as what we learnt from textbook. but when i saw his x ray, it was a "boot-shaped" heart as he had right ventricular hypertrophy. according to the paeds trainee, he was very bluish last time and underweight. they fed him and his weight gone up dramatically. although his weight still abit low for his age but it was within the acceptable range and he was fit for the surgery. he came back on week2 after the surgery with vomiting and diarrhoea. he looked more pinkish and had a midline scar on his chest. the stool was sent to the lab and came beck to be positive for clostridium difficile. he was on conservative treatment to maintain fluid balance but his weight had came down after the surgery. he did not have enough nutrition as he kept vomiting. they tried to feed him through NG tube but his vomiting and diarrhoea havent settle even after taking 5days of metronidazole. the consultant was trying to get hold of the microbiologist and dietatian, as he needs nutrition and gain more weight. let's pray for him...