Department of Pediatrics, Children's National Health System, Washington, District of Columbia.
Division of Hospital Medicine and
Pediatrics. 2019 May;143(5). doi: 10.1542/peds.2018-0412. Epub 2019 Apr 5.
A 21-month-old previously healthy girl presented to the emergency department initially with fever, rhinorrhea, and poor oral intake. She was subsequently discharged from the hospital on amoxicillin for treatment of acute otitis media but presented hours later on the same day with continued poor oral intake, decreased urine output, and lethargy. The patient was afebrile on examination without a focal source of infection or evidence of meningismus, but she was lethargic and minimally responsive to pain and had reduced strength in the upper and lower extremities. Initial laboratory analysis revealed leukocytosis with a neutrophil predominance and bandemia, hyponatremia, mild hyperkalemia, hyperglycemia, elevated transaminases, a mild metabolic acidosis, glucosuria, ketonuria, and hematuria. Follow-up tests, based on the history and results of the initial tests, were sent and led to a surprising diagnosis.
一位 21 个月大的既往健康女孩因发热、流涕和食欲不佳而首先到急诊科就诊。她随后因急性中耳炎接受阿莫西林治疗出院，但在当天晚些时候出现持续的食欲不佳、尿量减少和嗜睡。体格检查时患儿无发热，无感染灶或脑膜刺激征的证据，但患儿嗜睡，对疼痛反应迟钝，上下肢肌力下降。初始实验室分析显示白细胞增多，以中性粒细胞为主，出现核左移，伴有低钠血症、轻度高钾血症、高血糖、转氨酶升高、轻度代谢性酸中毒、糖尿、酮尿和血尿。根据病史和初始检查结果，进行了后续检查，结果出人意料。
