Vomiting with Ventricular Septal Defect

Dr Ira Shah

doi:https://

Vomiting with Ventricular Septal Defect

Dr Ira Shah.

Medical Sciences Department, Pediatric Oncall, Mumbai, India.

ADDRESS FOR CORRESPONDENCE
Dr Ira Shah, 1, B Saguna, 271, B St Francis Road, Vile Parle {W}, Mumbai 400056. India

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Clinical Problem
A 6 month old boy with congenital moderate ventricular septal defect {VSD} on decongestive measures consisting of frusemide and digoxin presented with irritability, vomiting and oliguria since 2 days. There is no fever, refusal of feeds or lethargy. On examination, he is malnourished {weight = 4kg}, with some dehydration, has heart rate of 100 , min and a pansystolic murmur at the apex. Other systems are normal

What is the diagnosis_? How to treat_?

Discussion
This child has presented with vomiting and oliguria. Oliguria may be due dehydration and decreased intravascular volume. The dehydration is because of persistent vomiting. Vomiting could be because of several reasons such as infection, gastritis or drug induced. This child has no fever or refusal of feeds. Thus infection seems an unlikely cause. Gastritis in a normally feeding infant is unlikely {There being no infection or nil by mouth}. Thus vomiting seems to be drug induced. Digoxin in toxic levels can lead to vomiting. Digoxin toxicity can also lead to bradyarrhythmia. In this child even though the child is dehydrated, there is no tachycardia. {Though bradycardia is not present, the heart rate seems to have remained normal due to simultaneous dehydration}. Thus, in this child the diagnosis is Digoxin toxicity. Serum digoxin levels in the child were elevated {2.7 {Normal being Less than 2.2}} Digoxin toxicity when diagnosed, one should stop Digoxin till Digoxin levels return to normal. FAB antibodies can be used to prevent digoxin effect.

Compliance with ethical standards

Funding: None

Conflict of Interest: None

Cite this article as:
Shah I. Vomiting with Ventricular Septal Defect. Pediatr Oncall J. 2011;8: 29.

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Vomiting with Ventricular Septal Defect
Vomiting with Ventricular Septal Defect 16/11/2010 16/11/2010 Ira Shah https://www.pediatriconcall.com/Journal/images/journal_cover.jpg Dr Ira Shah. Medical Sciences Department, Pediatric Oncall, Mumbai, India. ADDRESS FOR CORRESPONDENCE Dr Ira Shah, 1, B Saguna, 271, B St Francis Road, Vile Parle {W}, Mumbai 400056. India Show affiliations
Clinical Problem A 6 month old boy with congenital moderate ventricular septal defect {VSD} on decongestive measures consisting of frusemide and digoxin presented with irritability, vomiting and oliguria since 2 days. There is no fever, refusal of feeds or lethargy. On examination, he is malnourished {weight = 4kg}, with some dehydration, has heart rate of 100 , min and a pansystolic murmur at the apex. Other systems are normal

What is the diagnosis_? How to treat_?

Discussion This child has presented with vomiting and oliguria. Oliguria may be due dehydration and decreased intravascular volume. The dehydration is because of persistent vomiting. Vomiting could be because of several reasons such as infection, gastritis or drug induced. This child has no fever or refusal of feeds. Thus infection seems an unlikely cause. Gastritis in a normally feeding infant is unlikely {There being no infection or nil by mouth}. Thus vomiting seems to be drug induced. Digoxin in toxic levels can lead to vomiting. Digoxin toxicity can also lead to bradyarrhythmia. In this child even though the child is dehydrated, there is no tachycardia. {Though bradycardia is not present, the heart rate seems to have remained normal due to simultaneous dehydration}. Thus, in this child the diagnosis is Digoxin toxicity. Serum digoxin levels in the child were elevated {2.7 {Normal being Less than 2.2}} Digoxin toxicity when diagnosed, one should stop Digoxin till Digoxin levels return to normal. FAB antibodies can be used to prevent digoxin effect.

Compliance with ethical standards
Funding: None
Conflict of Interest: None


Cite this article as: Shah I. Vomiting with Ventricular Septal Defect. Pediatr Oncall J. 2011;8: 29.