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Symmetric peripheral gangrene in child with severe sepsis

Symmetric peripheral gangrene in child with severe sepsis

Presenting complain : Fever, two episodes of convulsion, altered consciousness of three days duration
Three year old female child, was well until she developed a sudden onset of  fever and tonic clonic seizures  . Each seizure  episodes lasted about 20 minutes.This happened while child was traveling with mother from Burkina Faso to Dadieso , a town in the Western Region. She was initially sent to a municipal hospital hospital and admitted.Two days into admission she was  referred to KATH
Only significant Child does not was haemotransfused for anaemia secondary to malaria about a year ago and made satisfactory recovery. Her pregnancy , birth , vaccination, developemental history were all normal.
She is the third child of three siblings who are apparently well. Both parents are young father 23yrs, mother 21 yers. Father lives at Burkina faso but frequents Ghana to work.
Temp : 38 deg Celcius,       SPO2( 94% without oxygen, 100% with oxygen ),    RBS 3.4mmol/l
Very ill looking young girl with petechiae all over her body. She was febrile
Cardiovascular system : CRT <2s , BP: 100/54 mmhg  , pulse rate 120bpm, heart sounds present and normal
Respiratory system : RR 32cpm , airway adequate bilateral, breath sounds vesicular with no added sounds.
Gastrointestinal system  : abdomen soft , no organomegally, bowel sounds present and normal
Central nervous system: BCS 5/5 …, kernigs positive
Diagnosis: meningococcal sepsis
Laboratory investigations :
HB 7.2g/dl,  MCV 67,  platelets 58,  WBC 14.75 ,  sodium 131mmol/l , chloride 98 mmol/lpotassium 2.7mmol/l
Initial management :
I.V KCL 20mmol in 40 mls of 5% dextrose at 6mls per hour
2. Tansfusion of 276 mls of packed RBC at 23dpm
3.Iv Ceftriaxone 1.5g daily for 7 days
Summary of reviews :
Child condition improved generally. Fever resolved over 72 hours of treatment. Feeding, physical activity improved  improved . child however developed rapidly progressive darkening of digits and toes. This worsened to formation  of dry gangrene. This was observed to be consistent with symmetric peripheral gangrene
Parents however absconded with child for no apparent reason. Attempts at tracing parents and child has proved futile


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