Pediatric Problem Solving - Case 23

Pediatric Problem Solving – Case 23
A 4 month old infant presents with fever and poor feeding. Examination revealed moderate dehydration, poor perfusion, and screaming. The WBCs count is elevated with shift to the left. Urine analysis of a catheterized specimen reveals red blood cells, white blood cells, and scant bacteria.
What is the most appropriate course of treatment?

A. Fluid restriction.

B. Surgical intervention

C. I.V. antibiotics therapy

D. Wait for culture results

Explanation of the case

Poor feeding in children means loss of function and leads to dehydration.

Poor perfusion is dangerous as it may lead to circulatory failure.

Screaming in children indicates pain.

Increased WBCs count with shift to the left = bacterial infection.

A catheterized specimen ( to avoid contamination) reveals red blood cells, white blood cells, and scant bacteria = Urinary tract infection Diagnosis : septic shock on top of UTI

Choice (A): point against: the infant is dehydrated; fluid restriction will worsen the condition.

choice (B) : point against: not indicated

Choice (C): right choice: as this case is a septic shock which may be complicated and cause death, so must be treated immediately.

choice (D) : point against : takes time, it should be done later after the patient start receiving I.V. antibiotics then change the treatment according to culture results.