Review 

of a clinical case 
of Pediatrics

VCC
 Steger Lara
Clinical History •Birth: 20.04.2009

• Female of 22 months.
• Reason for consultation:
– She had fever (> 39 º C) for 4 days of evolution before going to the doctor.  In the
weekend , Lara went to the doctor but he diagnosed her of otitis media. She got
worse, with fever, cough and vomiting, 
so she returned to hospital on 16th Wednesday and income.
• Personal Histoy:
– No relevant disease before
– No surgery
– Lactose intolerance: She eats special products without lactose
– No treatment before the disease
– She is not vaccinated against pneumococcal
• Family Histoy:
– Her grandmother was ill too. After than Lara was admitted to the hospital, the
grandmother was diagnosed with pneumonia.
 Clinical course
Lara income on 16th February with malaise, cough, fever (37,1ºC)
and dehydration. She was tired.
She was drinking quite normal but was eating less
In the exploration at the income, she was diagnosted of bacterial
pneumonia and of Molluscum contagiosum.
The following day she  seemed to improve, not vomited, but was soft,
and in the night some days she was bad.
The lung wasn’t improve, it was humid and poorly ventilated
On 20th, she had fever again and she vomited, but with the treatment
she looks good
She plays at times but gets tired easily
The last days she looks better, she has not vomited, and she is eating,
drinking and playing good, but her lung is not good still and she soon
tires
Laboratory:
Testing for diagnosis
• Blood gas analysis
• Complete blood count

16/Feb/2011:
• Chloride 95mmol/l (96-108)
• Phosphate, inorganic: 0,86mmol/l (1,10-
1,95)
• RCP: 30,97mg/dl (0,00-0,70)
• Co2 partil pressure: 32,7 mmHg (37,5-50,0)
• O2 partil pressure: 79 mmHg (36-44)
• Standard base excess: -5,3 mmol/l (-2,0-3,0)
• Standard bicarbonate: 20,3 mmol/l (21.0
-26,0)
• 02 Saturation: 95,7 % (70,0 – 80,0)
• Leukozyten 27,2 G/l ( 6,0-15,5)
• Segment-nuclear neutrophil: 73,0% (21,0-
67,0)
• Lymphocyte: 11,5% (20,0-64,0)
• Monocytes: 11.5% (5,0-11,0)
• Plasma cell: 0,5% (0,0-0,0)
21/Feb/2011:
• RCP: 6,41mg/dl (0,00-0,70)
• Erythrocyte: 3,46 T/l (3,9-5,50)
• Hemoglobin: 92 g/l (110-140)
• Hematocrit: 0,273 l/l (0,330- 0,400)
• Thrombocyte: 597 G/l ( 223-515)
• Absolute reticulocyte 27,7 G/l
(34,0-124,0)
• Leukozyten 27,2 G/l ( 6,0-15,5)
• Segment-nuclear neutrophil: 69,0
% (21,0-67,0)
• Lymphocyte: 18,8 % (20,0-64,0)
• Monocytes: 11.5% (5,0-11,0)
 Testing for diagnosis
Rx Thorax:
Lobar or segmental pneumonia is
a type of pneumonia characterized
by lesions of an
entire lobe or a large segment of the
lung and usually affects or commits all lung
structures in the affected region.

She has an alveolar infiltrate of the middle

lobe in the right lung .

Pulmonary auscultation:
Crackles

Analytical Stool
Adenovirus? Rotavirus?
 Actual Investigation
• ANAMNESIS INVESTIGATION: His mother says she eats and drinks more and has not needed oxygen
since the last fever two days ago. She don’t have diarrhea. She has not returned to vomit since two
days ago

• FISICAL INVESTIGATION:
• Good general condition, but she is somewhat nervous and she coughs a bit
• Temp. 36.6ºC, height 86cm, weight 10,3kg, BMI 13,9, Pulse 93pm,
• Pink skin and mucous membranes. But She is mildly dehydrated. The skin is dry. She presents a few
papules of molluscum contagiosum, but they seem to be improving.
No bruising / petechiae / bleeding
• Head and face:
– Humid Tongue. Pink, She has normal tonsiles
– Neck: no adenopathies or vascular breaks.
• Thorax: moves well.
– AP: Still wet with ventilation deficit
– AC: Normal. No murmur. Easily palpable peripheral pulses
• Abdomen: no organomegaly. Painless. Soft.
• Tips / Locomotor:
– Superior, inferior and Hip: normal mobilization, painless, nor limited.
• SN: cranial nerves normal. Strength, tone and ROT preserved. No alteration of the sensitivities, No
Babinski. Initiating and coordinating normal. No meningeal signs.
 Judgment diagnosis
• Pneumonia
– Steptococo?
• Dehydratation
– Vómitos
• Adenovirus?
• Rotavirus?
• Norovirus?
• Mollusco contagioso
 Treatment
• Noko

• Claforan i.v 3x 350mg

=100 mg /kg/d  7 days

• Elo Mel brasis 40ml/l iv.

• Elo Mel isodon 500ml iv.

• Biocef 100mg/5ml ov. (start when finished Claforan iv.)

1 week (<4ml 2x4ml)

• Mexaler supp. 125mg.

If T>38,5ºC max.3xd

• O2
If saturation < 93%