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Diangosis (DX) and Discussion of Child with Fever & Belly Pain

This 9 year old girl came to the ER because of agitation, confusion, fever, belly pain, and sore throat.

Any child with fever, agitation, and confusion should be suspected of a more serious disease such as sepsis, meningitis, brain disorders, metabolic disorders, poisoning, and dehydration. A spinal tap or lumbar puncture and other blood tests like blood sugar and other chemistries were done and were normal in this child. A normal lumbar pucture rules out bacterial meningitis.

The X ray of the belly was normal. It was requested because of the belly pain. CT of the belly was requested because the child was not getting better. The CT showed signs of ruptured appendix.

Her appendix was removed. She was given intravenous antibiotics (ampicillin and gentamicin). She recovered after 10 days.

Because of the ruptrued appendix she developed sepsis or widespread bacterial infection from Escherichia coli. This was shown by her blood culture. Sepsis is a result from tissue damage caused by the body response to endotoxins of the bacteria.  If sepsis is not treated early this could lead to many organ dysfunction, changes in mental status, shock, and death. Sepsis is a medical emergency.

In younger children, belly pain, agitation, confusion, and fever can be a manifestation of intussuception. It is an intestinal obstruction from infolding or telescoping of the walls of the intestine. This can be serious also if the diagnosis is delayed. The treatment of intussuception is a procedure called barium enema, and at times surgery is necessary.

[Reference:  Pediatrics In Review, December 2002, page 433]

Leo Leonidas, MD, FAAP, Assistant Clinical Professor in Pediatrics, Tufts University School of Medicine, Boston; Attending Pediatrician, Eastern Maine Medical Center, Bangor, Maine

Please send my your suggestions and comments to improve this site:

lleonidas@pcpediatrics.org

I wrote and desinged this website for parents of our practice. Before you use ideas from this website, please discuss it first with your clinician if you are not with our practice.

copyright Leo Leonidas 2002

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