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| SPECIALIST ANSWERS
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Question |
Dear sir 5y old boy present to ED as fever+prolonged febrile fit & treated as such.The next day was still febrile+ deep coma.No history of trauma ,drugs or recent chicken pox.On exam. nothing apart from fever + deep coma which persist for 10 days.Investigation done 1.normal csf 2.cbc normal 3.widal-ve 4.cxr is nomal &cat scan mild brain atrophy 5.EEG global dysfuntion.The pt. was treated as viral encephalitis[iv zovirax + cefitriaxone + steroid +mannitol + ng feeding] what else can be done for this poor pt.?
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Answer |
Since CSF is normal and other tests are also normal, the child seems to have encephopathy rather than encephalitis. There is slight brain atrophy on scan and one should rule out HIV infection. Also rule out Inborn errors such as Lactic acidosis, Glutaric acidemia, Fatty acid oxidation defects and Reye's syndrome. Do a venous blood gases, serum lactate and pyruvate, urine orgainc acids and amino acids and serum ammonia and sugar. An MRI of the brain will also be useful.
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