Child With Generalised Body Swelling,Breath Lessness,Effort Intolerance and Head Ache

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Rakesh Kumar, Binay Ranjan, Manjul Vijay Department of Pediatrics, Katihar medical college, Katihar...

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	Specialist Answers
Question
9 year male child presented with generalized body swelling ,breathlessness, effort intolerance and head ache of acute onset. Swelling started from lower limbs then reached abdomen with breathlessness. There was no history of joint swelling, cough, decreased urine output, no rashes, no loc either such previous illness in the past. he was not hospitalized, nor was no medications. He was tachypnic, anasarca, pale, tachycardia, but NO RADIO FEMORAL DELAY, all peripheral pulsations felt gallop rhythm, wide fixed split second heart sound, grade 4 psm, with normal first sound ,jvp was raised, tender hepato megaly with ascitis, there was basal creptations bilateraly. The echo revealed ASD,USG-abdomen revealed non visualization of right kidney which was conformed with CT abdomen, RFT ,LFT,ASO <200 ,serum electrolyte revealed within normal limit,irrespective of his improvement of the CCF. He is persistent to have a BP of 190/140 mm hg, and is not responding to first line anti hyper tensive medication .What is the probable diagnosis? What further investigation should be carried out? Which medication would you like to add on ? The following values could not retrieve result :- which medication would you like to add on? What further investigation should be carried out, not responding to first line anti hyper tensive medication? What is the probable diagnosis, irrespective of his improvement
Answer
It may be hypertension induced cardiac failure. Rule out coarctation of aorta and aortoarteritis. A color doppler of abdominal as well as thoracic arota would be advisable. Also check blood pressure in all 4 limbs. If there is aortoarteritis, rule out autoimmune disorders. Control BP with nitroprusside or even nitroglycerine drip in ICU setting. Back to All Questions

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