pl read these invest alongwith my previous question posted just now.

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Yes definately uti should be included in the d/d of failure to thrive as dr rajesh sir used to teach us back at rani hospital . Miss working there ..
It could be hyperthyroidism not hypothyroidism as tsh is low but free t3 is low too .these r contradictory so thyroid report is wrong. In evening i went through repeated abg.cbc reports done during last 3 -4 admissions and found wbc.platelets always high and in abg chloride mostly high and ph low.lowest was 7.02 with very low hco3 pointing towards metabolic acidosis.it was corrected by ivf and antibiotics and discharged.baby mosty got admitted due to diarrohea with dehydration with above biochemical derangements. Occas had pneumonia and cxr and babys chest presently suggested. It was surprprising to detect bulging fontanalle in this baby which is not recorded anywhere in hospital document.hc still is 39 cm at 5 months so its arrested hydrocrphalus.no us or ct or mri done. Repeat tb gold today came -ve from same lab who gave +ve 2 wks ago so att was stopped.its simply a negligence in management of the case which is a case probably of 1.malabsorption 2.pneumonia 3.recurent diarrohea 4recurrent severe acidosis with extreme hypocarbia and hypokalemia and hyperchloremia.the probable cause could be RENAL TUBULAR ACIDOSIS. 5.HYDROCEPHALUS probably due to Torch ventriculitis.TORCH serology not done. 6.humoral imunodeficiency associated with malabsorption and recurent pneumonias and failure to thrive.immunoglobulins not done. So the end diagnosis not digged out even after repeated admissions which is surely not expected from such tertiary centre. I didnt find any ur c/s report which is i think a grave missing. Many more indeed is needed in this case to unearth and finally reach to a conclusive diagnosis. The case is presented not to degrade or humiliate any of us but simply for discussion .its true no one is a complete doctor or having complete knowledge.we all lack in some or other field or subject or sections.
Crp once was 26.all other crps were normal. Wbc count highest found is 28k. Ferritin i think was done to diag HLH in which its more than 500 even in face of anemia.or was done as part of anemia. It is normal in this case.so ida of moderate grade is posdibility if supported by low iron and high tibc.it too vaguely indicates hemolysis but high retics wold support which is not done till date.
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No final diagnosis.all suspected diag is as i wrote above.in the discharge attached enteral sepsis was the diag abt which i havent heard.it shld be AGE with sepsis
Today many other reports i wll get .urc/s may be among them .if not done then its missed as the baby most likely is having uti since leucocytosis still persists.
Yes theres persistent thrombocytosis . Wbc more than 15000 holds significance . Wheres crp . Why serum ferritin was carried out .
Hb is normal . No bicytopenia . MCV is oki too . Then serum ferritin . What was the final diagnosis
Seems to b a case of central hypothyroidism . Vit d3 is low in every other children .
Overall its a complex case of FTT and much more detailed work up is needed.
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