Presentation is loading. Please wait.

Presentation is loading. Please wait.


Similar presentations

Presentation on theme: "Fever."— Presentation transcript:

1 Fever

2 Case 1: 7 months old girl 3 days fever
General condition worsening last 2 days Sleepy, but gives good contact when awake Eats less than usual, but drinks OK and has wet dipers No rhinorrhea, coughing, vomiting or diarrhea Previously healthy

3 Examination Sleeps initially, but wakes up and gives contact
No smile, uncomfortable, but the mother is able to calm her Skin color and turgor normal. Mucus membranes wet Tonus OK Capillary refill time 2 sec RR 45, HF 160, T 39,5, SaO2 95% Auscultation: normal heart and lung sounds

4 Lab CRP 235 Urine bag sample: leukocytes +++, blood +, protein +, nitritis – Catheter sample confirms the results, with positive microscopi

5 Management Diagnosis? Admit to hospital? Other solutions? Follow up?

6 Urinary Tract Infections

7 History General condition Fever Focal infectious symptoms? Vomiting
Feeding Consciousness Hydration (diuresis) Fever Focal infectious symptoms? Vomiting Previous history: ultrasound during pregnancy

8 Clinical examination Typically no focal signs of infection
General appearance – septic? Respiratory frequence Heart Rate Capillary refill time Skin colour Consciousness Activity

9 Laboratory investigations
Urine sample Leukocytes sensitive, nitritis specific Collection bag sample can only be used to exclude UTI! Midflow sample, catheter or bladder puncture Microscopy Urine culture Blood sample CRP, WBC, kreatinin, Na, K, Hb, urea, blood gases Blood culture

10 Imaging Chest x-ray? Ultrasound Voiding cystourethrogram DMSA
Scintigraphy Acute diagnostic of pyelonephritis and chronic renal scarring

11 Treatment Oral Mecillinam, Trimetoprim-sulpha, (3rd gen cefalosphorin), (Amoxicillin-clavulanate) i.v ampicillin-gentacimin, mecillinam, cefotaxim

12 Risk factors <6months Septic No effect of treatment within 48 hours
Pathologic prenatal ultrasound Residiving pyelonephritis Non E.coli Unusual presentation (older boys) Heredity for vesikuloureteral reflux High kreatinin or BP

13 Case 2: 2 months old boy High fever 1,5 day No vomiting or diarrhea
Eats ok, diuresis normal General condition slightly reduced, more sleepy

14 Examination No smile, but excellent contact. Good activity
No focal signs Auscultation: normal

15 Lab: CRP 131 Urine sample (mid flow): Leukocytes 3+, blood 2x, protein 2+, nitritis + Admit to hospital?

Download ppt "Fever."

Similar presentations

Ads by Google