This child has paralytic ileus which was initially thought to be due to hypokalemia. However, with the improvement of serum potassium, the ileus still persisted. Thus, other causes such as intestinal obstruction and infection should be kept in mind. The blood culture is negative. The child also has edema suggestive of either hypoalbuminemia or capillary leaks. In this child, with prolonged PT and PTT with low platelet count, capillary leaks seems a possibility along with hypoalbuminemia. (The low
Albumin may be due to loss of
Albumin in interstitial space). Thus this child has deranged PT, PTT, thrombocytopenia, capillary leaks, initial leucopenia, hepatic transaminase dysfunction and fever suggestive of Dengue hemorrhagic fever. In this child, on suspicion of dengue. Dengue IgM ELISA was done which was positive (3.34 units).
Thus, paralytic ileus may be a presentation of dengue and if a child presents with intestinal obstruction along with capillary leaks and coagulopathy, one must suspect viral hemorrhagic fevers along with sepsis.