Diagnoses, Signs and symptoms Flashcards
Name 6 causes of dehydration due to excessive loss of fluid
- Excessive sweating (fever, hot climate, cystic fibrosis)
- Vomiting (pyloric stenosis, viral infections, gastroenteritis)
- Acute diarrhoea (viral+ bacterial gastroenteritis, antibiotic induced, food poisoning, acute infection)
- Burns
- Post surgery
- Polyuria (diabetes mellitus, SIADH)
Name 2 causes of inadequate intake of fluids-> dehydration
- Inability to drink (herpes stomatitis, acute tonsillitis)
* Inadequate access to water
What investigations should be carried out in a child with severe dehydration?
- U+Es (electrolyte imbalance and renal function)
- Blood gas (metabolic imbalance)
- Urinalysis (osmolality)
- Blood sugar (DKA?)
- Stool culture (in gastroenteritis and food poisoning)
How do you assess degree of dehydration?
Mild: only sign is dry lips, (<5%)
Moderate: dry lips, reduced urine output, lethargic, tachycardia, normal BP, delayed cap refill, sunken fontanelle, reduced skin turgor (5-10%)
Severe: dry lips, no urine output for last 12 hrs, irritable/coma, tachycardia, low BP, very delayed cap refill, very sunken fontanelle, very reduced skin turgor (>10%) = hypovolaemic shock
Treatment of severe dehydration
- Oral rehydration where possible
- Treat shock with bolus of IV fluids
- Rehydrate slowly over 24hrs
- Correct electrolyte imbalance
- Do not prescribe antibiotics is uncomplicated gastroenteritis
- Probiotics?
What metabolic imbalances would you expect in someone who’s profoundly dehydrated due to diarrhoea?
Metabolic acidosis: Bicarbonate loss from persistent diarrhoea
Hyponatraemia: When diarrhoea contains lots of sodium
What metabolic imbalances would you expect in a persistently vomiting patient
Metabolic alkalosis due to H+ loss in vomit
How can IgE be used in diagnosis?
- Total IgE may be used to help screen for and detect allergic disease
- Allergen specific IgE tests may also be used if potential allergens have been identified
What symptoms would indicate an IgE test to be ordered
- When a person has periodic or persistent symptoms that may be due to an allergic reaction
- Symptoms: itching, hives, eczema, N+V, diarrhoea, coryzal symptoms, difficulty breathing, asthma symptoms
What does an IgE elevation indicate?
Likely person has 1/more allergies
Can also indicate a parasitic infection
What tests are done to investigate a weakness in muscle
- History
- Examination (eg against resistance/gravity)
- Neuroimaging (stroke)
- LP
- Electromyography
- Muscle biopsy
Name 9 infections that can cause muscle weakness
- Epstein-Barr virus
- Human immunodeficiency virus
- Influenza
- Lyme disease
- Meningitis (multiple agents)
- Polio
- Rabies
- Syphilis
- Toxoplasmosis
What drugs can cause arm weakness?
- Alcohol
- Chemotherapy agents
- Antiretrovirals
- Corticosteroids
- NSAIDs
- Statins
- Penicillin, sulphonamides
What genetic conditions can cause arm weakness?
Muscular dystrophy
Mitochondrial disease
What platelet issues can cause a purpuric rash?
Impaired platelet production (leukaemia, aplastic anaemia, myeloma)
Drug induced platelet reduction (co-trimoxazole, chemicals)
Excessive platelet destruction (immune mediated, DIC, haemolytic uraemic syndrome)
Splenomegaly
Dilutional loss
Name 7 non-platelet causes of a purpuric rash
Congenital infection (rubella, cytomegalovirus)
CT disorder (haemorrhagic telangiectasia)
Septicaemia, meningococcal infections, measles
Autoimmune (HSP, SLE, rheumatoid arthritis)
Drug induced (steroids, sulphonamides)
Senile purpura
Scurvy
What tests need to be done in someone presenting with purpura
FBC (rule out leukaemia/aplastic anaemia)
INR (if on warfarin)
Plasma electrophoresis (hypergammaglobulinaemia, paraproteinaemia)
Autoantibody screen (SLE, rheumatoid)
Blood culture (meningococcal/septicaemia)
What questions need to be asked in a child presenting with failure to thrive
See growth chart-> age of onset Food input (dietary hx, time of weaning, hunger) Energy output (energy, activity, exercise, anorexic?) Output: wet nappies, stools, GI symptoms
Which systems would you review in failure to thrive?
General (fever, behaviour/activity/alertness/cough)
GI: dysphagia, reflux, vomiting, abdo pain/colic, diarrhoea, constipation, stools)
Name 7 GI causes of failure to thrive
Coeliac Dietary protein intolerance (cow's milk) Carbohydrate intolerance (lactose) Pyloric stenosis GORD Cystic fibrosis IBD
Name 4 behavioural causes of failure to thrive
Not enough food offered Nutritional neglect Emotional neglect Eating disorder Poor feeding technique (eg problems latching)
