ISSN - 0973-0958

Pediatric Oncall Journal



Dr Ira Shah.
Medical Sciences Department, Pediatric Oncall, Mumbai.

Dr Ira Shah, Medical Sciences Department, Pediatric Oncall, 1, B Saguna, 271, B St. Francis Road, Vile Parle {W}, Mumbai 400056.
Clinical Problem
Case Report:- A 6 months old boy presented with progressive distension of abdomen for 4 days associated with swelling over feet and eyes for past 2 days. He had fever with diarrhea 2 weeks ago. On looking at the child, he has anasarca. The abdomen is distended with upper quadrant appearing fuller as compared to lower quadrant. He is also well nourished.

What is the cause of ascitis in this child?
Expert’s opinion:- Dr Ira Shah

This child has anasarca which may be due to cardiac, renal, liver or PEM status. Cardiac edema usually starts in feet and increases as day progresses. Renal edema usually starts in the eyes and decreases as day progresses. Liver edema starts predominantly with ascitis and then involves other parts of the body. PEM edema affects generally all body at the same time. Thus, in this child, swelling first started with ascitis and then progressed to rest of the abdomen. Thus, liver cause seems a possibility. Moreover, the upper quadrant of abdomen is more as compared to lower quadrant suggestive of organomegaly such as hepatomegaly, splenomegaly or hepatosplenomegaly. Thus in this child liver disease with hypoalbuminemia seems to be the cause. This child is well nourished and has no jaundice or skin bleeding. Thus, chronic liver disease seems unlikely. With a history of fever and diarrhea 2 weeks ago, an acute hepatotropic viral infection seems plausibility such as Hepatitis A, E or Dengue which can lead to a sub acute hepatitis with ascitis. Extra hepatic portal hypertension, Budd Chiari syndrome can also cause ascitis but would not cause anasarca. In this child, Dengue antigen test was positive and Hepatitis A was also positive. The anasarca subsided with salt restriction and diuretics.
Compliance with ethical standards
Funding:  None  
Conflict of Interest:  None
Cite this article as:
Shah I. Hypoalbuminemia. Pediatr Oncall J. 2008;5: 145.
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