FI

NALEXAMI
NATI
ONOFPAEDI
ATRI
CS
NAME:Manupat
iGangadhar
STUDENTNUMBER:
1816130121
1.Whatist
hecauseofvi
tami
nDdef
ici
ency？Whati
sthedi
agnost
ic
cr
it
eri
aforr
icket
sofv
itami
nDdef
ici
ency
?
CAUSESOFVI TAMI NDDEFICIENCY: Themostcommoncauseof
Vit
aminDdef i
ciencyislackofpropernutr
it
ion.I
tcanalsobeduet o
geneti
cdisor
der s,
butthisi
srare.Thedisor
dersare25-hydroxyl
ase
defi
ci
ency,1-alpha-hy
droxyl
asedefici
encyandheredi
taryresi
stance
tovi
taminD.
•Diet:Lowlev elsVitD,cal
cium phosphat e.Phosphat edefici
encyi
n
dieti
srareexcepti npret
erm babiesast heyrequir
eincreased
phosphatefort hei
rgrowth.Sunli
ght: Inadequateexposur eto
sunli
ght.vit
.Di scall
edsunshinev i
tamin..•mal absorpti
on(f at
solubl
ev i
tamins), CLD(chronicliverdiease).Drugs: Longt er
m use
ofanticonvul
sant, antit
ubercul
ardr ugsespeciall
yIsoniazid
(inducesCytP450→ f ormsinactiv
ev itD).
Cysti
cfibr
osis,Cr
ohn'sdiseaseandceli
acdi sease:Thesecondit
ions
canpreventyouri
ntesti
nesf r
om adequatel
yabsor bingenough
vi
taminDt hr
oughsupplement s,especi
all
yiftheconditi
onis
untr
eated.
Obesit
y:Abodymassi ndexgreaterthan30isassociatedwi t
hlower
vit
aminDl evel
s.Fatcell
skeepv i
tami nDisolat
edsot hatit
’snot
rel
eased.Obesit
yoftenrequi
rest aki
nglargerdosesofv i
taminD
suppl
ement storeachandmai ntainnormal l
evel
s.
Kidneydiseaseandl i
verdi
sease: Theseconditi
onsr educethe
amountofcer tainenz ymes( hepati
cenzyme25–hy droxyl
asefrom
yourli
verand1- alpha-hydr
oxy l
asefrom yourkidneys)yourbody
needstochangev i
taminDt oaf ormitcanuse.Al ackofeitherof
theseenzymesl eadst oani nadequatelevelofacti
vev i
taminDi n
yourbody .
Cert
ainmedi cati
onscanl owerv it
ami nDl evels,includi
ng:Laxati
ves,
Ster
oids(suchaspr ednisone),Chol esterol-
lower ingdrugs(suchas
chol
estyr
ami neandcol esti
pol)
, Seizure-cont r
ol drugs(such
asphenobarbitalandpheny t
oin),Ri
fampi n(at uber cul
osisdrug)
,
Or
li
stat(
awei
ght
-l
ossdr
ug)
.
DI
AGNOSTI
CCRI
TERI
AFORRI
CKETSOFVI
TAMI
ND
Serum : .*Cal cium : Decr eases/nor mal .•Phosphat e:
Decr eases.I mpai redabsor pti
onf rom i ntest i
ne&i ncreased
excr eti
onofphosphat eunderPTHi nf l
uence.Par athyroid
hormone: Increases.I tcausesost eoclastact i
vationl eadingt o
boner esorption.Thus, br i
ngingcal cium tonor mal cy.•
Alkal i
nephosphat ase(ALP): I
ncr easesduet obonea
Radi ological r
esor ption.•ashy droxychol ecalciferol(pr ecur sor
form: sensitivemar ker)(Act i
v efor m: 1,
25
Dihy droxychol ecalciferolcannot•Pr eferredf ordi agnosi s.•x
rayshows: change: Lossofnor mal zoneofpr ov i
sional
calcifi
cat i
on(2PC).Thi sresultsi ni rr
egul arit
yatt heendof
met aphy sis(f raying).Cuppi ng(cupl i
keshape)andspl aying
(wi deningofgr owt hpl ate/l ateraldev i
ation).I nchi ldren,the
suspect edj ointsar eX- rayedandchar acteristi
cchangesi nt he
bonesmaybedet ected.Bl oodt estsmi ghtal sor eveal high
l
ev elsofpar athy r
oidhor mone( PTH)andal kali
nephosphat ase
(ALP) ,andl owl ev elsofcal cium, phosphor usand25( OH) D( a
mar kerf orv i
tami nDl evels).

2.Male,5y
rolddoubleeyel
iddr osy2day s,
coughtwoweeks
ago.whichl
aborat
oryexami nationwereneededforthedi
agnosi
s
ofnephroti
csyndr
ome? pleasedi scusst
hecomplicati
onsoft
he
di
seasewhi chweneedt opr event?
Labor
ator
yexami
nat
ionf
ordi
agnosi
sofnephr
oti
csy
ndr
ome:
1.Ur
inet
est
:ur
inepr
otei
n3+
2.Occul
tbl
ood+-
Bi
ochemi
cal
exami
nat
ion:
24hrur
inepr
otei
n:5.
22g/
day
,bl
ood
chol
est
erol
8.
8mmol /l
,
bloodtotalprotein(
TP) :
42.8g/
l,
(60-
83)
,al
bumin(ALB):
18.3g/
l(35-55),
ASO: Lessthan25.0I
U/ml(
0-116),
C3
1.
15g/L(
0.70-2.
06),C40.22g/L(0.11-0.61)
ENA:Antidsdnal
esst han
20I
U/ml,
ANA: 5.
82AU/ ml
.
Rout
ineur
ine:
prot
ein3+,
RBC6/
ul,
(0-
22,
WBC/
ul,
19(
0-22)
uri
ne
cul
tur
e(-
)
Physi
cal
exami
nat
ion:
Eyel
i
dandl
owerl
i
mbsedema,
non
depr
essi
on.

Compl icati
ons:Compl i
cationsofNSar edi videdi ntotwocat egor i
es:
disease-associatedanddr ug-rel
at edcompl icati
ons.Di sease-associated
compl i
cationsincludei nf
ect i
ons( e.
g.,peritoniti
s, sepsis,cel
luli
ti
s,and
chickenpox )
, t
hromboembol i
sm ( e.g.
, v
enoust hromboembol i
sm and
pulmonar yembol i
sm), hypov olemiccr isis(e.g.,abdomi nalpain,
tachycardia,andhy pot ension) ,
cardiov ascularpr oblems( e.
g.,
hy perli
pidemi a)
,acuter enal fail
ure,anemi a, andot hers(e.g.,
hypothy roi
dism, hypocalcemi a,bonedi sease, andi ntussusception).
Themai npat homechani sm ofdisease-associ atedcompl icati
ons
ori
ginatesf rom t helargel ossofplasmapr oteinsintheur ineof
nephr oti
cchi l
dr en.Themaj ori
tyofchil
dr enwi thMCNSwhor espondto
tr
eat mentwi thcor ti
costeroidsorcytotoxicagent shav esmal lerand
mildercompl icationsthant hosewi t
hst eroid-
resistantNS.
Corticosteroids, alkyl
ati
ngagent s,cycl
ospor i
nA, andmy cophenolat
e
mof etil
.haveof tenbeenusedt otreatNS, andt hesedr ugshav e
tr
eat ment -
relatedcompl icati
ons.Earl
ydet ectionandappr opriate
tr
eat mentoft hesecompl i
cati
onswi l
li
mpr oveout comesf orpat i
ents
wit
hNS.
3.
Thediff
erencesofCSF(
cer
ebr
ospi
nalf
lui
d)among
bact
eri
a,
vir
us,t
ubercul
osi
smeni
ngi
ti
sandnormalcsf
.

CONDI
TION PREDOMI
NANT PROTEI
N GLUCOSE SPECI
FICTEST
CELLTYPE
Nor
malCSF Alll
ymphocyt
es† <40 >50%of None
(0–5cel
ls/
mcL) mg/dL blood
glucose
Bact
erial Leukocy tes El
evat
ed <50%of Gr am st aining( yiel
d
5
meningit
is (usuallyPMNs), blood i
shi ghi f10 col ony-
oftengr eat
ly glucose for mi nguni tsof
i
ncr eased (maybe bact eria/mLar e
extremel
y pr esent )
l
ow) Bact er i
al culture
PCRormul ti
plex
PCRpanel if
av ailabl e
Vi
ral Lymphocytes El
evat
ed Usual
ly Mul tiplexPCRpanel
meni
ngi
ti
s (maybemi xed; normal orconv ent ional PCR
PMNsand (tocheckf or
l
ymphocytes ent er ov i
rusesor
duri
ngthefirst her pessi mpl ex,
24–48hour s) her peszost er ,
or
WestNi lev i
rus)
IgM ( tocheckf or
WestNi lev i
rusor
ot herar bov ir
uses)
Tubercul
ous PMNsand El
evat
ed <50%of Aci d- fastst aining
meningit
is‡ l
y mphocyt
es blood PCR
(usual
lymixed glucose My cobact er i
al
pleocy
tosi
s) (maybe cul tur e(ideal l
yusi ng
extremel
y aCSFsampl eof≥30
l
ow) mL)
Inter feron- gamma
test sofser um and
(ifav ai l
abl e)CSF
Xper tMTB/ RIF§
4.
Howt odiagnoseKawasaki
disease.
pleasedi
scusst
het
reat
mentof
Kawasaki
di sease.
Kawasakidi
seaseisanacut
e,syst
emicvascul
i
tisthatpredominant
lyaf
fect
spat
ient
s
youngert
hanfiv
ey ear
s.I
trepr
esentst
hemostpr ominentcauseofacquir
edcor
onaryar
ter
y
diseasei
nchi
ldhood.

Classi
c(typi
cal)Kawasaki di
seasei sdiagnosedbasedont hepresenceofaf everlasti
ngf i
ve
ormor edays,accompaniedbyf ouroutoff i
vefindings:bil
ateralconj uncti
valinjecti
on,oral
changessuchascr ackedander y t
hemat ouslipsandst rawber r
yt ongue,cervical
l
ymphadenopat hy,ext
remitychangessuchaser ythemaorpal m andsol edesquamat i
on,and
polymorphousrash.I
ncompl ete(atypi
cal)Kawasaki diseaseoccur sinpersonswi t
hf ever
l
astingfi
veormor eday sandwi thtwoort hr
eeoft hesef i
ndings.Tr ansthoracic
echocardi
ographyisthediagnost i
cimagi ngmodal ityofchoi cetoscr eenforcor onary
aneurysms,alt
houghot hertechniquesarebei ngev aluatedf ordiagnosi sandmanagement .

•Thediagnost
iccr
it
eri
aincl
udef
everf
ormor
ethan5day
sandatl
eastf
ouroft
hef
oll
owi
ng
feat
ures:

•Bi
l
ater
al,
pai
nless,
non-
exudat
iveconj
uti
vi
ti
s.

•Lipsororal
cavi
tychanges(
li
pcr
acki
ng,
fissur
ing,
str
awber
ryt
ongue,
inf
lammat
ionoft
he
oralmucosa).

•Cerv
ical
lymphadenopat
hy(
1.5cm i
ndi
amet
er,
uni
l
ater
al,
non-
pur
ulent
).
Pol
ymor
phus
exant
hema

•Extr
emit
ychanges(
rednessofpal
m andsol
es,
swel
l
ingofhandandf
eetwi
thsubsequent
desquamati
on)

Thet
reat
mentofKawasaki
disease.

1.i
ntr
avenousi
mmunogl
obul
i
n:2g/
kgi
nfusi
on

2.Highdoseofaspi
ri
n:80t
o100mg/ kg.Ant
i-
inf
lammat
ory,
Cont
inuedt
il
lpat
ientaf
ebr
il
e
for48hour
s,t
henwecandecreasedosoge

3.LowdoseAspi
ri
n(3t
o5mg/
kg/
day
),Cont
inuedt
il
l6t
o8weeks

Af
ter6t
o8weeks,
Echocar
dogr
aphyhast
obedone:

.
IFECHONor
mal
:St
opAspi
ri
n.

.
Cor
onar
yabnor
mal
i
ties:
Cont
inueAspi
ri
nti
l
lnor
mal
i
zed

Treatmentforacutediseaseisintr
avenousi mmunogl obul
inandaspi ri
n.I
fthereisno
responsetotreatment,pati
entsaregivenaseconddoseofi ntrav
enousi mmunogl obuli
n
withorwithoutcorti
coster
oidsorotheradj uncti
vetr
eatments.Thepr esenceandsev er
ityof
coronaryaneurysmsandobst ructi
onatdi agnosisdet
erminetreatmentopt i
onsandt heneed,
peri
odicit
y,andintensi
tyoflong-t
erm cardiovascul
armonitori
ngf orpotenti
alather
osclerosi
s.
5.Tom,male,11yrol
dcough5day s,
highfevert
hreedays,
PE:moi
stralescanbeheardinbot
h
l
ungs.Bloodr out
inewbc24. 2*10^6perl
i
t r
e,N80%，L15%Hb11.4g/l
,plt
319.0*10^
9/l
,
crp
45mg/l .
pleasediscussthediagnosisandanalysethedi
agnost
icbasis,
discusst
he
complicati
onoft hedisease.
•Di
agnosi
sisl
obarpneumoni
abyst
rept
ococcuspneumoni
a.
Di
agnost
icbasi
s:
Labor
ator
yfi
ndings:Elev
atedwhit
ebloodcell
count
s:morethan15000/micr
oli
tr
efr
equentl
y
accompanybacter
ialpneumonia.
Howev eral
owwhitebl
oodcount(
lesst
han5000micr
olit
re
canbeanominousf indi
nginthi
sdisease.
Imaging:chestradi
ographi
cf i
ndingdef i
nebact
eri
alpneumonia.pat
chyinf
il
tr
ates,at
elect
asi
s
,hi
alradenopat hyorpleur
aleffusi
onmaybeobser ved.
radi
ogr
aphshouldbet akeninthe
l
ateraldecubitusposit
iontoidenti
fythepleur
alfl
uid.Complet
elobarconsol
idati
onisnota
commonf indi
ngsininfantsandchildren.
Specialexaminat
ions:
invasi
vediagnost
icpr
ocedure(
transt
rachealaspi
rat
ion,
bronchi
al
brushingorwashing,
lungpunctureoropenort
horacoscopiclungbiopsy)
shoul
dbe
undertakenincri
ti
call
yil
lpati
ents.
Compl icati
ons:emphysemamayoccurf requent lywit
hst aphylococcal ,
pneumococcal and
groupAhemol y
ticstr
eptococcaldi
sease.Distal sitesofinfecti
ons-Meni ngi
tis,
oti
ti
smedi a
,sinusi
ti
s(especial
lyoftheethmoids)andsept icemi amaybepr esentparti
cularl
ywi t
h
diseaseduet os.pneumoniaeorH. i
nfluenzae.Cer tai
nimmunocompr omi sedpatientsthose
whohav eundergonesplenectomyorwhohav ehbssdi seaseort halassemi aareespeciall
y
pronetoov erwhelmingsepsiswiththeseor gani sms.Diatalinf
ectionoft hebones,joi
ntsamd
otherorgans(l
iverabscess)mayoccuri ncertainhost swi thspecifi
cor ganisms.

6.October23,A2y rol
dgirlpr
esent
swi thahistoryofpassing10-15wat erstool
sfor5days
,andhasv omitedatl
east4ti
mesi nlast24hours.sheappear sl
ethargy,herl
imbsarecold
andt heskinisdryshecriesbutnotears,anuri
afor12hr sherwei ghti
s12kgbef oresick
.thenursei nf
ormsy outhatherweightis10.5kgpulsei
s10. 5kg,pulseis136beatsper
mi nutet
emper ature37.
9candpr essure65/40mmhgser um sodium 136mmol /l.
please
discsussthediagnosisamdmanagementoft hechil
d.
Diagnosi
softhi
schi
ldi
s–AcuteGastroent
eri
tisSev
ereDehy
drati
onwit
hAcuteDi
arr
hea.
Thechildhasl
ostal
most12.
5%.ofherweightandherser
um sodi
um i
slesst
han130
mmol /L.
Thediarrheai
sinacutestageasthecourseis5day s,i.
e.,l
essthan2weeks.Insev er
e
diar
rhea:Mostofthecasesarenon-i
nfect
iousdiar
rhea( r
otavi
rus,shi
gel
la)
.Frequencyof
stooloft
enmor ethan10times/day
.Wat eryst
ool,plentyofmucus.Generalcondit
ionis
poor,usuall
yaccompanywi t
hvomiti
ngandf ever,
dehy drat
ionandelect
rol
ytedist
urbance.
Mai
nli
nesofmanagementi
ncl
ude:
1.Feedi
ng:
Cont
inuef
eedi
ngt
hechi
l
d,Gi
veasmuchast
hechi
l
dwant
s.Gi
vesmal
lfr
equent
feedsEncour ageanor exi
cchil
dt oeat.Forbreast-f
ed: conti
nuebreastf eedingasusual
duringandaf terdiarrheaandr ehydr
ationtherapy.Forf or
mula-f
ed: l
owl actoseorlact
ose-
freef ormul
aonl yincaseofl actoseintol
erantchil
dren.onmi xeddiet:continuenormal
feedingasusual ,givef r
equentsmall f
eeds,av oi
dtoosweet enedoroilyf oods,avoi
dfoods
cont aini
ngahi ghfibercontent|
2.Fl
uidt
her
apy
3.Dr
ugsi
nthemanagementofdi
arr
hea:
-Ant
imi
crobi
alagent
s
a)Notr
ecommendedf
orv
iral
diar
rhea
b)Inv
asiv
epat
hogenandt
oxi
cpat
hogeni
nfect
ionshoul
dchooseef
fect
iveant
imi
crobi
al
agents
c)Anti
biot
icsshoul
dbest
oppedorchangedf
ort
heant
ibi
oti
cassoci
atedi
arr
hea.
Anti
parasi
ti
c
Pr
obi
oti
cs:
Lact
obaci
l
li
,Bi
fi
dobact
eri
a
Ant
idi
arr
heal
agent
s:Absor
bant
sandmucousmembr
anepr
otect
ors-

7thanswer)Diagnosi sisneonatalrespi
rat
orydistresssy ndr
ome:
i
ncludi
ngtransienttachypneaoft henewborn,pulmonar yairleak
di
sorders(pneumot horax,pneumomedi ast
inum),neonat alpneumonia,
meconium aspirati
on,persist
entpulmonaryhypertensionoft henewborn,
andthebroadcat egori
esofcy anoti
ccongenitalheartdiseaseand
i
nterst
it
ial
lungdi sease

Infantswit
htransi
enttachy pneaofthenewbor nhaveimpai red
resorpti
onofthefetal
lungf l
uidandhavemar kedtachypneasoonaf t
er
birth,
butsymptomsgener all
yimproveafter24hours.Chestr adi
ogr
aph
showsper i
hil
arstr
eaking,representi
ngper i
hil
ari
nterst
it
ialedema,
withoutthedi
ffuseret
iculo-granul
argroundglassappear anceofRDS.
Pulmonaryairleaksy ndromessuchaspneumot hor axand
pneumomedi astinum mayal sopr esentasr espi
rat
or ydi
str
ess,butthe
onsetofsympt omsmaybemor eacut e.Othercli
nicalcl
uesinclude
chestri
seasy mmet r
y ,anddiminishedbr eathsoundsononesi deofthe
chest.Hyperl
ucentar easonchestr adiographycanbeappr eciatedift
he
ai
rleakissignifi
cant.Pulmonaryi nterstit
ialemphysemaaf fectsinf
ants
whoar emechani cal
lyv
ent
il
ated;symptomsofr espi
rat
orydist
ressoft
en
occurlat
erthanex pect
edwit
hRDS, andthetrappedairwit
hinthe
peri
vascul
artissueshasacharacter
ist
icappearanceofcysti
clucenci
es
onchestradiography.
Bacteri
alpneumoni a,especi
all
yrel
atedtoGroupBSt reptococcusi
na
newbornisoft encli
nical
lyandradi
ographi
cal
lyindist
inguishabl
efr
om
RDS.Thepr eferredtr
eatmentincl
udesempiricalanti
biot
icsinaddi
ti
ont
o
respi
rator
ymanagement .
Inf
antswi
thcyanoti
ccongenit
alheartdiseasemayhav esi milar
symptomscli
nical
l
y,butwil
lnothavethedi f
fusereti
culo-granular
groundgl
assappearanceonchestradiography.Theradiologicalf
indi
ngs
dependontheunderl
yinganat
omicabnor malit
y .

Management:managementofneonat alrespir
ator
ydi st
resssy ndrome
i
ncludedecreasinginci
denceandsever
ityusingantenatal
cort
icoster
oids,
f ol
l
owedbyopt i
malmanagementusi ngr espir
atory
support,
surfact
anttherapy
,andover
allcareofthepremat ureinfant.

Ant
enat
alcor
ti
cost
eroi
ds
Moni
tor
ingoxy
genat
ionandv
ent
il
ati
on
Assi
stedv
ent
il
ati
onoft
heneonat
e
Exogenoussur
fact
antt
her
apy
Support
ivecar
e,i
ncl
udi
ngthermoregul
ation,
nut
ri
ti
onal
suppor
t,f
lui
dand
el
ectr
olyt
emanagement,ant
ibi
oti
ctherapy,

ha
8t nswer
)Di
agnosi
s:Di
abet
icket
oaci
dosi
s
Di
abet
icket
oaci
dosi
sisaser
iouscompl
i
cat
ionofdi
abet
es.
Thecondit
iondev
elopswhenthebodycan'
tpr
oduceenoughi
nsul
in.
I
nsul
inplaysakeyrol
einhel
pingsugar—amajorsour
ceofener
gyfor
muscl
esandot
hert
issues—ent
ercel
l
sint
hebody
.
Withoutenoughinsul
in,t
hebodybeginstobreakdownf atasfuel
.This
causesabuildupofacidsinthebl
oodstr
eam call
edketones.I
fit'
slef
t
untreat
ed,t
hebuildupcanleadtodiabet
icket
oacidosi
s.
I
fyouhavediabetesoryou'
reatr
iskofdi
abet
es,l
earnthewarni
ngsi
gns
ofdi
abet
icketoacidosi
sandwhentoseekemergencycare.

Physi
cal
examinat
ion:
T<35°
C;P120/
min;
R16/
min;
BP78/
49mmHg;
H
112cm;W 20kg;BMI15.
8kg/m2

•Obnubi
l
ation,
pal
lor
,li
mbscold,t
heskini
sdryandlessel
asti
cSclera
waswhit
eandconjuncti
vacl
ear,
hisfundi
werenormalwi
thsharpdisk
margi
ns,andhehadnohemorrhagesorpapi
l
ledema.
Thr
oatr
ed,
thy
roi
dwasbar
elypal
pabl
eandwi
thoutnodul
es
Therewerenopalpablepreaur
icul
ar,
postaur
icul
ar,
occi
pit
al.t
onsi
l
lar
,
submandi
bular
,cerv
ical,
orsupracl
avicul
arl
ymphnodes
Chestwassymmetri
cal
,br
eat
hingwasdeepl
yandsl
owl
y,
lungswer
e
cl
eart
oauscul
tat
ion.
•Ar
egul
arhear
trat
eandr
hyt
hm wi
thacr
ispS1andS2wi
thout

mur
mur sorext
rasounds.Api
cal
pul
sewasatt
he4t
hint
ercost
almar
gin,
mi
dclav
icul
arli
ne.
Abdomenwassof
tandnont
enderwi
thnor
mal
act
ivebowel
sounds,
nor
eboundt
ender
nessorguar
dingwaspr
esent
,no
pal
pabl
ehepat
ospl
enomegal
y•Nor
ashesorpet
echi
ae
Bl
oodrouti
ne:
WBC9.
3*109/
L,NE%70%,
LY%20.
4%,
CRP7mg/
L,PCT
0.
4ng/
ml .
Thy
roi
dst
imul
ati
nghor
monel
evel
wer
ewi
thi
nnor
mal
li
mit
sHCO3-
ABG: PH:
7.16,
PaCO2:
12mmHg,Pa02:
117mmmHg, 3.
4mmol
/L,
Lact
ate:
3.1mmo/L,
BE:
-15.
7mmol/
L,AG:34.
6mmol
/L
BUN:
15.
9mmol
/L,
Cr:
147mmol
/L,
K+:
8mmol
/L,
Na+:
120mmol
/L,
CI
-
:80mmol
/L,
Glu:
33mmol
/L
Ur
inal
ysi
s:ket
one:
3+,
grav
ity
:1.
024,
glu:
4+,
negat
ivef
or
Pr
otei
n.
HbA1cwaselev
atedat17.
3%,
whi
chi
ndi
cat
eda3-
mont
hav
eragebl
ood
gl
ucoseof25mmol/L.
chestX-
ray(
-)•ECG(
-)
.
Basi
soft
hedi
agnosi
s:Cl
i
nical
present
ati
on,Bl
oodgl
ucosel
evel
Hemogl
obi
nAl
c
Tr
eatment
:Fl
uidresusci
tat
ion,Insuli
n,Ant
i-
inf
ect
ion,Di
et,
Blood
gl
ucosemoni
tor
ing,
Exerci
s,Education.
Reexami
nat
ion:ABG:
PH:
7.36,
PaCO2:
45mmHg,
Pa02:
104mmmHg,
BE:
-
I
mmol
/LBUN:
3.7mmol
/L,
Cr:
87mmol
/L,
K+:
4.7mmol
/L,
Na:
137mmol /
L.CI
-105mmol /
L,Glu:5.6mmol
/LUr
inal
ysi
s:ket
one:
-,
gr
avi
ty:
1.022,gl
u:-
,negat
iveforprotein.