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Forum Name: Pediatric Topics

Question: wanted help understanding


 spongebobkids - Tue Dec 06, 2005 2:12 am

I had my almost 4 year old daughter to the Er on thanksgiving night with a high temp 102.6 and stomach pain. They did blood work (CBC, differential, renal studies), straight cathed her and a chest x-ray. The Er doc said that on the chest x-ray there was possibly something on her lung that looked like pneumonia but wasn't sure. She treated it as pneumonia though even though my daughters' lungs sounded clear. Today I got copies of her blood work and urine results and the Dr. report. The blood work was alright except her MPV was 7.0 ,RDW was 11.4, NEUT was 95.9, LYMPH 5.8, ABS NEUT was 9.7,sodium 134, CO2 17, Creatinine .3. Her urine test results were fine except for the ketones were 40 glucose was 85. The x-ray report in the Dr report reads " Chest x-ray demonstrated an area next to the right cardiac border where there is some obscuring. This possibly suggests of an infiltrate. X-ray was interpreted be me in the absence of a radiologist, and there are 2 views. Should I be worried about diabetes with her urine showing ketones? There is a long history of diabetes on both sides of the family. Would you please explain the blood test results I posted.
 spongebobkids - Tue Dec 06, 2005 2:30 am

Also not sure if this would be important her pulse was 153 when we arrived at the ER. It went down to 120 when we Left the ER
 Dr. Heba Ismail - Fri Dec 09, 2005 7:35 am

It could be a pneumonia, which could present with fever and abdominal pain, if it occurs in a lower part of the lung. But a radiologist has to have a look at those X-rays, or she may need a re-ray, if the first one is not clear.
In addition, pnuemonia should also be diagnosed by auscultating the chest with a stethoscope.
As for the lab studies, the differential count needs to be interpreted in terms of the percentage of each in relation to the total WBC count.
Her sodium and creatinine levels are normal.
The increased heart rate is explained by the presence of fever.
 spongebobkids - Fri Dec 09, 2005 10:19 am

This is the complete results of My daughters Blood work
CBC

Normal units results
WBC 4.5-15.5 10*3/ul 11.3
RBC 3.9-5.30 10*6/ul 4.41
Hgb 11.5-15.5 g/dl 13.1
HCT 34.0-45.0 % 38.4
mcv 70.0-95.0 fl 86.9
MCHC 31.0-37.0 g/dl 34.2
MPV 7.5-10.5 fl L7.0
RDW 11.5-14.5 % L 11.4
Platelet count 140-400 10*3/ul 294



Differential
NEUT 25.0-59.0 % H85.9
Lymph 30.0-56.0 % L5.8
MONO 0.0-12.0 % 8.2
Eosinophil 0.0-8.0 % 0.1
Basophils 0.0-1.0 % 0.0
Abs NEUT 1.0-8.0 10*3/ul H9.7
Abs LYMP 0.6-3.2 10*3/ul 0.7
Abs MONO 0.0-1.0 10*3/ul 0.9
Abs EOS 0.0-0.6 10*3/ul 0.0
Abs BASO 0.0-0.1 10*3/ul 0.0


RENAL STUDIES

Sodium 136-146 mEq/L L 134
Potassium 3.5-5.0 mEq/L 4.1
Chloride 100-110 mEq/L 102
CO2 19-32 mEq/L L 17
BUN 7-21 mg/dl 10
Creatinine 0.6-1.2 mg/dl L0.3
1/Creatinine 3.33
Glucose 74-127 mg/dl 85
Aninon Gap 3-16 15
 spongebobkids - Fri Dec 09, 2005 10:23 am

The Er DR listened to her lungs and heard nothing
 Dr. Heba Ismail - Fri Dec 09, 2005 1:57 pm

The increased neutrophil count and the decreased lymphocyte count are of concern here, but are explicable in the presence of infection, probably bacterial.
A follow-up CBC with a differential count should be done after one week from the previous.
The other lab studies are more or less acceptable.
Has your daughter improved on the antibiotics given?
 spongebobkids - Sat Dec 10, 2005 1:15 pm

She continues to run a low grade temp (100.0) and occasionally complains that her belly hurts.
 Dr. Heba Ismail - Tue Dec 13, 2005 1:39 pm

It can happen sometimes that after a severe infection has resolved, tissue breakdown would continue for a while causing the low-grade fever, but this is only one possible explanation.
If she has not been seen again by a doctor for follow-up, I suggest you do, just for re-assurance.
 spongebobkids - Wed Dec 21, 2005 2:36 am

I have for a long time been concerned about my daughter as she is only slightly bigger than her 2 yr old brother, bruises easily and about once a month vomits for no reason as far as I can tell. I always keep track of what she eats and so far can find nothing that causes it. We have had her to a gastroenterologist who found nothing to physically cause her to vomit. Also Her Dr is having us take her to speech therapy the beginning of the year he thinks her speech center is not developing properly. With the way her blood work reads am I being unnecessarily worried or should I be more pushy with her Dr?
 Dr. Heba Ismail - Fri Dec 23, 2005 7:37 am

Concerning her growth, I would like to know her percentiles.
As for the vomiting, does it occur just once during the day, or more than that? And is it severe enough to cause dehydration?
Is there a regular pattern for her vomiting? Is it related to fever, headaches or cough?
 spongebobkids - Mon Dec 26, 2005 11:29 pm

Why are the increased neutrophil count and the decreased lymphocyte count are of concern. She is at about the 50th percent for height and weight.I'm going to check with her Dr tomorrow. My son who is not quite 2 is about 75 for weight and 90 for height. As for the vomiting it is usually 2 or 3 times a day with no pattern it can happen at any time and I always push fluids when she stops to avoid dehydration. There is no fever, cough or headache and she usually is fine after vomiting. I work in the health care field myself as a nurse aide but with the elderly and I have asked the nurses I work with about her symptoms but they have not heard of anything that might cause this. I really appreciate all the time you are taking to answer my questions
 Dr. Heba Ismail - Wed Dec 28, 2005 8:37 am

Well, the lab results just mean that the infection may have been severe, and a follow up CBC is needed to confirm that these findings have disappeared with treatment of the infection.
As for her percentiles, the 50th is good enough, provided these values are maintained and it's not dropping.
The vomiting doesn't appear to have an organic cause and may be psychic.
 spongebobkids - Thu Dec 29, 2005 12:56 am

I have an appointment with my daughters Dr today at 3pm. Hopefully I'll get more answers. I got copies of all papers about the tests and x-rays from her visit to the ER. Now I'm really worried as the chest x-ray was normal. What would cause her blood work to be what it was if it wasn't pneumonia. Also another thing about my daughter it is taking for ever for her hair to grow back (long story short about 7 months ago she tried to cut her and her brothers hair and both had to be shaved) My sons' hair is already about 1 1/2 inches long my daughters' is only about an 1/2 inch. Her hair is really brittle and breaks easily. When her hair was longer there were times when she would have a hat on that when she would take it off there were clumps of hair.
 spongebobkids - Wed Jan 11, 2006 1:51 am

Sorry for not replying sooner but her Dr wasn't concerned by her blood work or even the fact the the x-ray showed the lack of pneumonia. He has refered her to a gastroenterologist but did not want to redo the bloodwork. I have set up an appointment with the gastro. Dr for the beginning of feb what should I request as far as tests go when we see the Dr.
 Dr. Heba Ismail - Fri Jan 13, 2006 7:54 am

An abdominal ultrasound primarily.
Then may be barium studies, an oesphageal manometry or pH monitoring for reflux. The decision to perform any of these depend on the doctor's judgement after evaluating her condition.
 spongebobkids - Thu Feb 02, 2006 7:40 pm

Well we went to the gastro yesterday.
He checked her over and has started her on prevacid. He gave me a very important bit of information. He said that alot of people with only one dose of ibprophen can have stomach problems. Next week my daughter goes for an upper GI test. He also said that if she has another bout of vommiting while on the prevacid to call them and they will schedule her for an endoscopy. I'm hoping for the best. I'm hoping that finally we are on the right track. I'll let you know what the results of the upper gi are.
Also something I thought about this evening was could possibly part of my daughters stomach be pushing through her diaphragm and would the upper gi show this. I will be contacting her Dr tommorrow about the possibility
 spongebobkids - Wed Feb 08, 2006 10:54 pm

Well we had the upper GI done and everything looks good. I don't know if that is good or bad because it is still a mystery as to why my daughter is vomiting the way she is. I'll keep you updated.

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