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Posted On : 29 Aug 2016
thai girl, 8 yrs old, underlying disease benign tumor at sacral area s, p remove 2 yr. after that she had neurogenic bladder, constipation and lower leg atrophy today she had problem anemia and fever day 3 PE: v, s BT 38.5 PR 100, min BW 18 kg, Ht. 125 cm. good conscious mod. pale , no jaundice no dyspnea, lung: no crep , lower limb: no pitting edema Lab CBC: Hct 18 MCV 80 WBC 13800 N83L17 Plt 250000, UA: single cath : wbc More than 100 rbc 3-5 epit 0-1, alb3plus, U, C: E.coli {ESBL} sense tienam, sulperazone other resistant , BUN, Cr 150, 12.4 E`lyte Na 129 K 4 CL 95 HCO3 18, Ca 8.1 Po4 =3 first treatment : Cef-34 days she still fever and u, c came back step to tienam {correct by GFR =4.6} and other treatment : FBC 13 , folic 11, vit D3 11, sodamint 23, caco3{ 1 g} 12, epo 50 U, kg 2 day, wk , I advice for long term renal replacement therapy and go to nephrologist but her mother deny, what i do for her more last treatment because I stay in district hospitalsorry about my english not well thanks
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Expert Answer :
Since the anemia is normocytic, it may be necessary to give her erythropoietin which is already being done. Rule out an underlying iron deficiency. Get her serum iron studies done. Since she has chronic kidney disease, she will need to be under care of nephrologist. You will have to talk to mother about dialysis and renal transplant that will be needed in the future.
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