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(Pediatrics in Review. 2006;27:29-33.)
© 2006 American Academy of Pediatrics

Index of Suspicion

The first 300 words of the full text of this article appear below.

	Frequently Used Abbreviations

 

ALT:

alanine aminotransferase

AST:

aspartate aminotransferase

BUN:

blood urea nitrogen

CBC:

complete blood count

CNS:

central nervous system

CSF:

cerebrospinal fluid

CT:

computed tomography

ECG:

electrocardiography

ED:

emergency department

EEG:

electroencephalography

ESR:

erythrocyte sedimentation rate

GI:

gastrointestinal

GU:

genitourinary

Hct:

hematocrit

Hgb:

hemoglobin

MRI:

magnetic resonance imaging

WBC:

white blood cell

	Case 1 Presentation

 
A 33-month-old African-American boy presents with a 3-day history of watery diarrhea; nonbloody, nonbilious vomiting; and the inability to tolerate oral fluids. Yesterday he developed "yellow eyes." No dark urine, fever, or other signs of illness have been noted. There has been no exposure to ill people or undercooked meats. He has had no serious illnesses, takes no medications, and has had all immunizations, including hepatitis B. There is no family history of blood disorders.

The child has a normal temperature and blood pressure but a heart rate of 143 beats/min. He appears tired and ill but is "feisty" with venipunctures. He has scleral icterus and buccal pallor, but no petechiae, purpura, or other rashes and no lymphadenopathy, abdominal tenderness, or hepatosplenomegaly.

His Hgb is 4.6 g/dL (46 g/L), Hct is 13.3% (0.133), WBC count is 16x10³/mcL (16x10⁹/L), platelet count is 405x10³/mcL (405x10⁹/L), and reticulocyte count is 9% (0.09). Blood chemistry results are normal except for a BUN of 43 mg/dL (15.4 mmol/L), creatinine of 0.7 mg/dL (61.9 mcmol/L), AST concentration of 105 U/L, ALT concentration of 19 U/L, total bilirubin level of 7.1 mg/dL (121.4 mcmol/L) (direct component, 0.2 mg/dL [3.4 mcmol/L]), and lactate dehydrogenase level of 3,850 U/L. His prothrombin time is 15 seconds and partial thromboplastin time is 26 seconds. Blood smear reveals increased nucleated red blood cells (RBCs), polychromasia, poikilocytosis, and "bite cells," but no spherocytes, sickled cells, schistocytes, or rouleaux formations. Urinalysis . . . [Full Text of this Article]

Craig P. Dobson, MD, CPT, MC, USAR
Walter Reed Army Medical Center, Washington, DC

Macelle Neuwirth, MD
Mt. Sinai Medical Center, New York, NY

Richard E. Frye, MD, PhD
Shands Hospital, University of Florida, Gainesville, Fla

Mark Gorman, MD
Boston Children’s Hospital, Harvard Medical School, Boston, Mass

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