a pt.2yrs old having a fever intermittent since 3-4days..presenting with dyspnoea ...spo2=71% . ..after hospitalisation repeated convulsive attack occur ...pt.react only while forcefull stimulation ...here after hospitalisation o2 therapy,iv fluid,inj ceftriaxone1gm bd,inj .amikacin 100mg bd inj gardenal inmaintanace dose,inj.histac ,nebulisation 8 hrly will given... o2 therapy omit since 5hr but pt.is still react on forcefull stimuli,excessive expectoration from mouth inspite of repeatedly sucction.... so plz give us to your expert opinion for further treatment of this child....



Summary: Toddler with fever, intermittent, s o br, hypoxemia, status epilepticus, copious oral secretions, coma+, Leucocytosis, CXR Increased BVM+, MP-ve, Raised ESR, CSF N. ? VIRAL BR PNEUMONIA WITH ENCEPHALITIS With STATUS ? ASPIRATION. ADVICED: FUNDOSCOPY, ABG , ECG , RPT CXR, Sr Electrolytes, Pupillary reflex to light, Disconjugate gaze abN, Gen Management:1)ABC care/Airway maintenance +O2/ MV if GCS<9, IV Anticonvulsants Epsolin / Levicetam Loading - maintenance IV mannitol + lasix IV Acyclovir IV Antibiotics Amp + Ceftriaxone in meningitis dose Iv Antipyretic IV fluids 2/3 of maintenance Monitor vitals, Urine output , BG, Electrolytes, Sr lactate, GCS, Temperature, Care of BBB Explain the prognosis and written consent for management,procedures and referral.

counts are mainly lymphocytic..csf m/e shows only 2 cells but both r lymphocytes.. still very high counts, short history, CXR not suggestive of tubercular etiology.. in such a dilemma treat as disseminated sepsis with mono+amika , antiepileptics and mannitol or 3%NS aftr doing the fundus examination.. still ask for family histry f koch, h/o on nd off fever, cough or wt loss Post d xray image if possible.. plzzz examine the fundus as well and get a neuroimaging( MRI ) done on urgent basis..

for d tym being get ESR done, apply Mtx . there are lot f secretions as u say, send it for AFB and strt glycopyrrolate to control them as d pt may otherwise drown in his own secretions..

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Cxr normal so wts 2D Echo report....cause of hypoxia to find out ...you should do EEG,MRI BRAIN,RBS,ABG,BLOOD CULTURE, CALCIUM,MAGNESIUM,ELECTROLYTE, RFT, urine routine...rashes??? Hepatosplenomegaly??? Residence of patient?? Continue inj.acivir, iv antibiotic...antiepileptic...maintain ABC.. KEEP updating of patient progress

Viral encephalitis, advised ICU management.

likely to b a case of viral encephalitis..MRI brain and CSF...study may b done..manitol can b aded..and if convulsion ..going on..convulsion should be controlled by addinng another AED

Treat as meningutus.refer if airway cannt be maintained for intubation

RBS is not done.History favour case of viral encephalitis require ct or MRI brain for hypoxic brain brain damage and other pathology.

rbs is145mg

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Appears to be viral encephalitis /persistent secretions can be because of on going convulsion (iv phenytoin)may be added, iv acyclovir, csf for herpes simplex (igm) neuroimaging if gcs <8 keep on venti r/0 tbm also....

child responding to paonful stimuli with pooling of secretion....kindly secure the airway with elective ventilation start acyclovir..viral encephalitis. mri required to rule out ADEM

Clear case of infective encephalitis Total wbc count is increased CSF tapping and send it for analysis Treat with higher IV antibiotic and anti convulsions treatment and antipyratic under ICU depending on investigation report treat the patient

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