Friday, August 26, 2011


There is a really sick little one at Amecet tonight. The Dutch nurse and I had our heads together for a while this evening and we just have no idea.  The child is nearly 18 months and weights about 6 kg. (13.2 lbs) She has had a high fever (up wards of 39.7 C or 103.4 F)  for more than 6 days. When she first spiked the temp they tested her for malaria and it was negative. The doctor treated her for it anyway. 3 days into treatment still no change. So they stopped the malaria meds and tested her urine- UTI (though that dx is dicey because they ALWAYS find stuff in urine here.) So she was put on amox.  No change.  So they changed her to IV ceftriaxone- a huge dose for a kid her size, after another negative malaria test. She has been on those IV antibiotics for 2 days. I saw her for the first time tonight. Her fever is still continuous, she is lethargic.  No vomiting or diarrhea but her abdomen terribly distended. However, this is normal in these kids that come in so malnourished so I don't that that is significant. Now her breathing is pretty rapid and tonight lungs sound pretty crackly but no cough and the ceftriaxone should still be addressing that right?  Am I missing something? No rash so I don't think it is measles or dengue fever. I can't find any enlarged nodes so I don't think it is mumps. Nothing indicates meningitis and we both think we can rule out typhoid.  I think the next step will be try to get a chest x-ray. Anybody want to jump into this discussion?
She has a sock on her hand to keep her from pulling her IV out. 
I'm happy to report her fever is down to 37.7 C (99.8 F) this morning. Still lethargic but continues to drink so we will continue to just watch her and wait.
Oh, by the way, I'm not in Karamoja. Transport was an issue so I'm still in Soroti.

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