PEDIATRICS
DATABASE
Name: Adaikkalam Lakshmi Gopikumar Preceptor: Dr. Abella Liong
Roll no: 02
Batch & section: IMD 25 & B
General Data:
Name: CLO
Age: 3 years
Gender: Female
Address: Panacan, Davao city
Religion: Christian ( seventh day Adventist)
Source of History: Mother and Patient
Reliability: 85%
Chief complaint:
Seizure
History of present illness:
One day prior to admission, the patient had one episode of vomiting in the
afternoon with the size of one cup and contains mostly undigested food (rice)
and no blood were noted, which was associated with blank stare for 5 min and
patient was unresponsive when the parents shook her. paleness, circumorally
cyanosis were also noted. She also had headache accompanied by this. The
patient was consulted private physician at the infirmary and advised to admit
In the hospital and the patient brought to SPH were the CBC, URINALYSIS and X
RAY was ordered and the result was increased WBC in the urine. The patient
was admitted at 1 am.
Past medical history:
Medical Surgical Allergies Trauma
Childhood
illness
No history of At one year of No No allergies to No history of
childhood age(2022), patient surgical any food or trauma
illness like had amoebiasis history medicines
chicken pox, and took
measles. cefuroxime as
treatment.
At at two year of
age(2023), patient
had pneumonia
and took
amoxicillin for
treatment. And
also had UTI and
took cefuroxime
as treatment.
Prenatal history:
Ob score - G2P2 ( 1 1 0 2)
Mother was 21 years old when she was pregnant with index patient
Maternal blood type: O+ve
Average weight gain: 13kg
Maternal medications taken during pregnancy: Vitamins
No of prenatal visits – 3 times
All deliveries were C.S due to CPD
Gravidity Year Methods of Outcome Complications
delivery
G1 2016 Vaginal Male -
delivery
G2 (index patient) 2014 CS Female Mother had genital
warts.
Birth history:
Duration of pregnancy - 36 months
Duration of labor (including early contractions) - 3 days
Caesarean section delivery - due to genital warts
Neonatal history:
Birth weight - 2.7 kg
Estimated AOG - 36 months
Status of baby after delivery - Pinkish in colour, Good cry, Active
No feeding difficulty
No physiologic jaundice
Length of stay in Hospital - 3 days
Reason - Caesarean Section
1st bowel movement noted within 24hours
Patient had neonatal sepsis
Newborn Screening Result - No pertinent findings
Hearing screening result - No hearing abnormalities
Nutritional history:
The patient is breastfed until 6 months
By 6 months the patient started eating rice, fruits, vegetables, cerelac
Patient eats well and there is no special diet followed.
Patient takes 3 or 4 times meal per day which includes 2 cups rice (4
cups when hungry), chicken, beef but no pork
Patient drinks 6 or 7 cups of milk per day
The father and mother is the one who usually feed the patient
Weight- 13kg
Immunization:
Vaccine Dose Age Side effects Hostpital
DPT 1 2 months - Primary health
2 4 months centre
3 6 months
Hepatitis B 1 Birth - Primary health
2 2 months centre
3 9 months
Polio vaccine 1 2 months - Primary health
2 4 months centre
3 10 months
MMR 1 12 months - Primary health
centre
Pneumococca 1 2 months - Primary health
l conjugate 2 4 months centre
3 6 months
Hib Type B 1 2 months - Primary health
2 4 months centre
Growth and development:
Age Gross motor Fine motor Social Language
1 months Turns head Hands fisted Discriminates Startles to
in supine near face mothers voice and
position voice sound
2 months Chest up in Holds hands - -
prone together
position
3 months Rolls to side Bats at Visually -
object follows
person
4 months No head lag Clutches at - Says “dada”
when pulled clothes plays and “mama”
to sit with rattle
5 months Palmar - Say AH-goo
grasps cube
6 months Sits crawl - -
momentarily
proposed on
hands
7 months - - Looks object Look toward
to parent familiar
object
8 months - - Lets parents Looks for
know when family
happy versus members
sad
9 months Stands on Bangs two
feet and cubes
hands together
3 years Able to run Able to Interacts Ability to
(present) and jump draw by with all the verbalize
tracing people feelings and
fingers emotions
Family history:
Ethnicity: Filipino
Diseases Relation
Hypertension Maternal grandfather, paternal
grandfather
Diabetes Maternal grandfather, maternal
grandma, paternal grandma
Asthma -
Cancer -
Heterofamilial diseases -
Personal and social history:
There are six members in the family
Mother is an event organizer and father is a virtual assistant
The father is primary care giver
Father smokes 6-7 sticks till 2017 and since last 2 years he is smoking 1
stick per day
Father drinks 3-4 bottles of alcohol per month and mother drinks alcohol
3 times in a month
Father went to third year college as lab tech and mother had one year of
college
Patient is friendly and interacts with most of the people
The patient uses phone, tablet and watch television 1 hours at a time.
Environmental history:
The patient lives in Panacan city, Davao city
Only few houses nearby to patient’s house and it is spacious
They drink mineral water
There is big sewage or water disposal nearby the house
The family is very hygienic and keep their hous clean and neat
There is 4 pet dogs in the house
The family is very hygienic and keep their house and surroundings clean
There is no factory near to the house
Review of systems:
• GENERAL: (-) weight loss, (-) poor appetite, (-) Fever
• SKIN : No lumps, No lesion, No Rash, No discoloration.
• HAIR: Hair growth is Normal, No Lanugo, No Hairloss
• HEAD: (+) Headache, (-) Trauma
• EYES :No Sunken eyes, No Redness, No discharge, No specs
• EARS: No discharge except usual ear wax, No Hearing Loss
• NOSE: No Bleeding, No Cold, No sneezing
• MOUTH: Pinkish dry lips, No ulcers, No Lessions
• NECK: No lumps, No Masses, No stiffness
• RESPIRATORY SYSTEM: No wheezing, (+) slight Cough
• CARDIAC: No syncope, No Chest pain.
• GIT: (-) LBM, (+) vomiting, No Blood in stool.
• URINARY SYSTEM: No Blood in urine, no dysuria
• NERVOUS SYSTEM: No hyperactivity, (+) Seizure, (-) tremor
• ENDOCRINE SYSTEM: No Cold Intolerance, No Diabetes
• MUSCULOSKELETAL SYSTEM: No dystopia, No asymmetry, Tone is normal
Physical examination:
Vital signs:
BP-90/60 mmHg Pulse rate : 82 bpm
RR -26 bpm O2 stat: 97
HR- 90 bpm Temp -37.2’C
Height- 104.9 cm BMI: 11.8
Weight - 11 kg
Activity: Awake, alert and oriented
Skin and Nails: Fair complexion, No Pallor, No surgical scars, No Rash, Skin
turgor is Normal, Nailbeds- slight pale
General Appearance : No asymmetry,No edema, No atrophy
Eyes: No sunken eyeballs, No Redness, conjunctiva is slight pale
Lips: Dry &Pinkish, No lesion
Nose: Congestion of Nose ,Mucus
Mouth &Throat : Dry lips, oral mucosa is pink, No tooth eruption, No perioral
cyanosis, No asymmetry, pharynx is hyperaemic
Chest and lungs:
Inspection: there is symmetrical chest expansion
Palpations: No tenderness, No tactile fremitus
Percussion: resonant sound, low pitched
Auscultation: no murmurs, gallops noted
Abdomen:
Inspection: no lesions, scars, rashes notes
Palpation: no masses, no splenomegaly, no tenderness
Percussion: tympanic sounds heard
Extremities:
Inspection: Upper and lower extremities are symmetrical in appearance
Palpation: No tenderness or deformity.
Babinski reflex: negative
Brudzinski reflex: negative
Kernig reflex: negative
Cranial Nerves
• Olfactory: able to smell
• Optic: able to watch cartoon from distance
• Oculomotor: on doing pupillary light reflex, pupillary constriction noted
• Trochlear: able to track objects, coordinated eye movements noted
• Trigeminal: able to chew
• Facial: facial expressions and smiles are symmetrical
• Vestibulocochlear: able to follow the command
• Glossopharyngeal: coordinated swallowing noted, presence of
cough, gag reflex intact, "aah" test - uvula in midline
• Spinal Accessary: symmetrical shoulders, can shrug shoulders
against resistance, good strength
• Hypoglossal: no abnormal tongue deviation, normal swallowing.
Growth charts:
Interpretation – normal for height
Interpretation- Normal for weight
Interpretation- severely wasted
Salient features:
• CLO is a 3 year old female who sought consult due to seizure
• patient had one episode of postprandial vomiting in afternoon. Vomit
consists of undigested food, about 1 cup per episode and no blood
• no medications were given
• laboratory tests were done includes CBC, X-Ray, urinalysis
• on urinalysis elevated wbc count was noted
• on day of admission the patient experienced seizure and blank stare.
• seizure was accompanied by a headache
• she didn’t respond to parents when they shook her head, experienced palor
and circumoral cyanosis for 5 min
• on kidney punch test, it showed pertinent negative
Differential diagnosis:
1. Meningitis:
Rule in: seizure, headache, elevated wbc count , vomiting
Rule out: negative kernig sign
2. Encephalitis :
Rule in: headache, seizure
Rule out: no fever
3. Epilepsy :
Rule in: no fever, blank stare
Rule out: no history of seizures
Final diagnosis:
BENIGN FEBRILE CONVULSIONS SECONDARY TO UTI
Epidemiology:
● Seizures triggered by fever, qualified as febrile seizures, have been for
decades a major issue for children in developed countries and more so in
resource-limited settings.
● Approximately 2-5% of children are affected by this kind of seizure.
● A febrile seizure is a convulsion in a child triggered by a fever, often occurring
in families, and most often in children between ages of 9 months and 5 years
according to the National Institutes of Health (NIH).
● Most febrile seizures occur in the first 24 h of an illness, and the fever has an
unexpected important weight; body temperature over than 38.3◦C increases
the risk factor compare to lower fever than 38.3◦C.
● Major upper airway infections such as ear infections, cold or viral infections
represent the main triggering factors
● Most often, febrile seizure has spontaneous resolution and does not require
any drug treatment.
Signs and symptoms:
● loss of consciousness
● Headache
● twitching of arms and legs
● breathing difficulty
● pale skin
Pathophysiology:
● Febrile seizures occur in young children at a time in their development when
the seizure threshold is low. This is a time when young children are susceptible
to frequent childhood infections such as upper respiratory tract infection, otitis
media and viral syndrome, and they respond with comparably higher
temperatures. Animal studies suggest a possible role of endogenous pyrogens,
such as interleukin 1beta, that, by increasing neuronal excitability, may link
fever and seizure activity. Preliminary studies in children appear to support the
hypothesis that the cytokine network is activated and may have a role in the
pathogenesis of febrile seizures, but the precise clinical and pathological
significance of these observations is not yet clear.
● Febrile seizures tend to occur in families. In a child with febrile seizure, the
risk of febrile seizure is 10% for the sibling and almost 50% for the sibling if a
parent has febrile seizures as well. Although clear evidence exists for a genetic
basis of febrile seizures, the mode of inheritance is unclear.
● Whereas polygenic inheritance is likely, a small number of families are
identified with an autosomal dominant pattern of inheritance of febrile
seizures, leading to the description of a "febrile seizure susceptibility trait" with
an autosomal dominant pattern of inheritance with reduced penetrance.
Although the exact molecular mechanisms of febrile seizures are yet to be
understood, underlying mutations have been found in genes encoding the
sodium channel and the gamma amino-butyric acid A receptor.
Management:
• Place your child on his or her side on a soft, flat surface where he or she
won't fall.
• Start timing the seizure.
• Stay close to watch and comfort your child.
• Remove hard or sharp objects near your child.
• Loosen tight or restrictive clothing.
• Don't restrain your child or interfere with your child's movements.
• Don't put anything in your child's mouth.
Drug study:
Drug cefuroxime
Brand name RiteMED
Administration Intravenous
Onset of action Rapid
Duration of action 18-24 hours
Absorption Rapidly absorbed form the GI tract
Distribution Widely distributed in body fluids
Metabolism Hydrolysed in the intestinal mucosa
and blood to cefuroxime
Excretion Excreted in urine
MOA By binding to specific penicillins
proteins located inside bacterial cell
wall, inhibits the third stage of
bacterial cell wall synthesis.
Side effects Nausea, vomiting, diarrhea, rash
Drug interactions Aluminium hydroxide, calcium
carbonate, magnesium hydroxide
Special precautions Patient with a penicillin or other
beta-lactam allergy; history of colitis,
history of seizure disorder. Patient
taking potent diuretics (e.g.
furosemide) and aminoglycosides.
Renal impairment. Children and
elderly. Pregnancy and lactation.
