INDEX OF SUSPICION
Geeta Berera MD1
Robert H. Dixon MD2
Willaim J. Koenig DO3
1 Harbor-UCLA Medical Center, Los Angeles, CA
2 Allentown, PA
3 Mayo Clinic, Rochester, MN
This section of Pediatrics in Review reminds clinicians of those conditions that can present in a misleading fashion and require suspicion for early diagnosis. Emphasis has been placed on conditions in which early diagnosis is important and that the general pediatrician might be expected to encounter, at least once in a while. The reader is encouraged to write possible diagnoses for each case before turning to the discussion, which is on the following page.
We invite readers to contribute case presentations with discussions.
Case 1 Presentation
A 24-mo-old boy is seen with a 2-d history of cough and fever. His past medical history includes recurrent vomiting and poor weight gain since 3 mo of age, and he has been hospitalized five times for dehydration. The child sat independently at 7 mo of age but is not yet walking.
On examination, he appears to be small and thin and is irritable. His temperature is 39.5°C(103.1°F), pulse is 150 beats/mm, and respiratory rate is 35 breaths/mm. The child's height, weight, and head circumference are all below the 5th percentile, but proportional. Except for nasal congestion and mild dehydration, the remainder of his examination is normal. Serum sodium is 140 mEq/L, potassium 3.5 mEq/L, chloride 117 mEq/L, and bicarbonate 11 mEq/L.
