Doctor Dalia
19-08-2005, 04:41 PM
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8 Year old child with acute progressive breathlessness
Clinical problem:
8 years old female child presents with breathlessness for last 4 days. It had been of gradual onset and worsening slowly. She did attend school during this period but with difficulty. On day of presentation to the doctor, she was unable to stand or walk. There was no history of fever, cough or any other symptoms. Past history was not contributory.
Physical examination revealed fairly nourished child.
Weight 24 Kgm Height 120 cms.
Temp- normal
Resp rate 45/min, alae nasi working, no chest retractions.
HR 120/min
BP 90/45 mms of Hg, no cyanosis or clubbing
Resp.system – normal CVS – normal
Other systems – normal
CBC, Chest x-ray and 2-D echo normal.
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Experts Opinion
Dr. Y.K. Amdekar replies:
Analysis:
Breathlessness is mostly a symptom of either respiratory or cardiac disease. Respiratory disease in older child (at 8 yrs.of age) of 4 days duration may be due to acute onset pleural effusion, pneumonia or asthma. Rarely it may result from acute laryngitis. All such respiratory diseases would have presented with other symptoms and physical signs. Acute onset cardiac disease leading to breathlessness at 8 years of age include myocarditis – either rheumatic or viral, pericardial effusion, acute hypertension as in acute glomerulonephritis or severe anemia resulting in cardiac decompensation. Like respiratory diseases, such cardiac diseases would present with many other symptoms and physical signs. Thus this child obviously is not suffering from respiratory or cardiac disease.
Less common causes of breathlessness include neurological diseases such as GBS or poliomyelitis, which are easily excluded in this child.
In final analysis, this child has presented with acute onset of gradually progressive breathlessness without any other obvious symptoms or any positive physical findings.
This may be just a functional disorder presenting with hyperventilation. However, it has been persistent and gradually worsening breathlessness over four days. Further careful analysis would indicate severe weakness in that this child was unable to stand or walk and has low blood pressure. Inability to stand or walk in this situation suggests muscle weakness without neurological signs and hence likely to be hypokalemia. Low blood pressure in absence of cardiac decompensation suggests low intravascular volume. In presence of hypokalemia and probable dehydration denoting fluid and electrolyte disturbance, breathlessness may denote tachypnoea due to acidosis. This triad of acidosis, dehydration and hypokalemia of acute onset would suggest Diabetes Mellitus.
Investigations:
Blood sugar 550 mgm%, serum K 2.2 meq/lit Urine showing sugar +++ and ketones +
Final diagnosis:
Diabetic ketoacidosis
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8 Year old child with acute progressive breathlessness
Clinical problem:
8 years old female child presents with breathlessness for last 4 days. It had been of gradual onset and worsening slowly. She did attend school during this period but with difficulty. On day of presentation to the doctor, she was unable to stand or walk. There was no history of fever, cough or any other symptoms. Past history was not contributory.
Physical examination revealed fairly nourished child.
Weight 24 Kgm Height 120 cms.
Temp- normal
Resp rate 45/min, alae nasi working, no chest retractions.
HR 120/min
BP 90/45 mms of Hg, no cyanosis or clubbing
Resp.system – normal CVS – normal
Other systems – normal
CBC, Chest x-ray and 2-D echo normal.
</FONT>
Experts Opinion
Dr. Y.K. Amdekar replies:
Analysis:
Breathlessness is mostly a symptom of either respiratory or cardiac disease. Respiratory disease in older child (at 8 yrs.of age) of 4 days duration may be due to acute onset pleural effusion, pneumonia or asthma. Rarely it may result from acute laryngitis. All such respiratory diseases would have presented with other symptoms and physical signs. Acute onset cardiac disease leading to breathlessness at 8 years of age include myocarditis – either rheumatic or viral, pericardial effusion, acute hypertension as in acute glomerulonephritis or severe anemia resulting in cardiac decompensation. Like respiratory diseases, such cardiac diseases would present with many other symptoms and physical signs. Thus this child obviously is not suffering from respiratory or cardiac disease.
Less common causes of breathlessness include neurological diseases such as GBS or poliomyelitis, which are easily excluded in this child.
In final analysis, this child has presented with acute onset of gradually progressive breathlessness without any other obvious symptoms or any positive physical findings.
This may be just a functional disorder presenting with hyperventilation. However, it has been persistent and gradually worsening breathlessness over four days. Further careful analysis would indicate severe weakness in that this child was unable to stand or walk and has low blood pressure. Inability to stand or walk in this situation suggests muscle weakness without neurological signs and hence likely to be hypokalemia. Low blood pressure in absence of cardiac decompensation suggests low intravascular volume. In presence of hypokalemia and probable dehydration denoting fluid and electrolyte disturbance, breathlessness may denote tachypnoea due to acidosis. This triad of acidosis, dehydration and hypokalemia of acute onset would suggest Diabetes Mellitus.
Investigations:
Blood sugar 550 mgm%, serum K 2.2 meq/lit Urine showing sugar +++ and ketones +
Final diagnosis:
Diabetic ketoacidosis
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