A two-week-old baby is brought to your general ICU in extremis pending transfer to a paediatric centre. Born at term, she had been discharged well on day 5 of life. For three days she has had progressive tachypnoea, lethargy and failure to feed, and has now presented after a seizure. She has been intubated in the Emergency Department.
Blood tests taken on air prior to intubation show:
Parameter | Patient Value | Normal Adult range |
pH | 7.04* | 7.35 – 7.45 |
PCO2 | 14 mmHg (1.9 kPa)* | 35 – 45 (4.6 – 6.0) |
PO2 | 80 mmHg (10.5 kPa) | |
Bicarbonate | 5 mmol/L* | 22 – 28 |
Lactate | 8 mmol/L* | <2 |
Glucose | 0.9 mmol/L* | 3.5 – 6.1 |
WCC | 14.7 x 109 /L* | 4.0 – 11.0 |
Neutrophils | 27% | . |
Lymphocytes | 70% | . |
ALT | 1600 U/L* | 10 – 55 |
AST | 2200 U/L* | 10 – 40 |
a) List, in broad terms, the key differential diagnoses for this presentation. (20% marks)
b) Outline your approach to differentiating between these diagnoses. (30% marks)
c) Outline principles of early management pending transfer. (50% marks)
a)
b)
History:
Examination:
Investigations:
c)
a) Differentials for this shock-like presentation:
Domain | Neonate/infant age group | Children older than 12 months |
Vascular |
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Infectious |
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Neoplastic |
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Drug-induced |
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Congenital |
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Autoimmune |
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Trauma |
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Endocrine or metabolic |
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b) Assessment of this shock state:
Generic to the infant/paediatric population | ||
History
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Examination
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Investigations
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Specific for the neonatal population: | ||
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c) Approach to management, which is very generic:
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