• Like
  • Save
Case presentation, Dr iman Ghabn,
Upcoming SlideShare
Loading in...5
×
 

Case presentation, Dr iman Ghabn,

on

  • 474 views

Case presentation, baby with hyperglycemia & brain cyst. By dr Iman Ghabn, El Nasr hosp, Port said, Egypt

Case presentation, baby with hyperglycemia & brain cyst. By dr Iman Ghabn, El Nasr hosp, Port said, Egypt

Statistics

Views

Total Views
474
Views on SlideShare
474
Embed Views
0

Actions

Likes
0
Downloads
11
Comments
0

0 Embeds 0

No embeds

Accessibility

Categories

Upload Details

Uploaded via as Microsoft PowerPoint

Usage Rights

© All Rights Reserved

Report content

Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
  • Full Name Full Name Comment goes here.
    Are you sure you want to
    Your message goes here
    Processing…
Post Comment
Edit your comment

    Case presentation, Dr iman Ghabn, Case presentation, Dr iman Ghabn, Presentation Transcript

    • Case presentation Dr.Eman Aly MohamedSpecialist of pediatrics & neonatology EL NASR N.I.C.U
    •  Female baby called Ganna neseem ,27 days old. C.S delivery ,not attended delivery ,G2-p2 birth date : 9/12 /2011 Gestational age : 34 w. (+/-) 2 w. was referred to our NICU from other hospital by : Severe respiratory distress. Cyanosis. Persistent vomiting. Persistent hyperglycemia.
    •  Chest xray CBC Blood glucoseTreatment: Antibiotics: cefotax,unictam N.G feeding &O2 by head box.Response to treatment was poor with persistent hyperglycemia and refer to our NICU .
    •  Admission date : 28/12 . The baby was severely hypoactive and depressed reflexes. Central cyanosis Waisted baby with loss of s.c fat of abdominal wall &both thighs Face ex.: no apparent abnormal features except low hair line. Mouth ex.: normal.
    • Chest ex.: Tachypnea, R.R 65/min Intercostals &subcostal retractions Fair air entery on both sides of chest wall Fine consonating &coarse cripits (bilateral)Heart ex.: H.R 135 beat /min. S1&S2 normal. No abnormal sounds.
    •  Abdomen is lax. Loss of subcutaneous fat. Loss of skin elasticity. Liver (++) below costal margin ,soft consistency, rounded border . Passes urine&stools
    •  Lower limbs ex . : Lax, no oedema Loss of subcutaneous fat over both thighs , no deformities. Upper limb ex. : Mild hypertonia,, fisting of both hands no deformities. Back&spines: Normal ,no deformities ,no masses External genitalia: normal appearance
    •  Length: 46cm. Weight: 1.9kg.on admission , birth weight was 2.5 kg. Chest circumference: 29cm. Skull circumferernce: 33 cm. on admission to our nicu. 34 cm. on stay in our unite Anterior fontanelle: soft,slightly depressed,3x5 cm. in size
    •  Plain x ray (chest&heart): bronchopneumonic patches Blood glucose: hyperglycemia Acetone in urine: absent Serum insulin: 2 micro unit /ml. Normal : 6 -24 micro unit /ml. C-peptide : 0.6ng /ml. Normal( 0.9-4) ng/ml.
    • Series Series Series Series Series Series Series Series Series Series Series SeriesSeries PM AM AM AM AM AM AM PM PM PM PM
    •  W.B.C count: 5.7 x 10 3/cubic mm R.B.C count: 2.9 x 10 3/cubic mm Hgb: 10.4 g/L H.c.t.: 30.7 Plt. 35 x 10 3/mm3 Differential count: - Lymph 26.2 % - Mon 21. 5 % - Gra 52.3 %Another C.B.C: normal after blood transfusion
    •  Sodium : 126 mmol/L (135- 150 mmol/L) Potassium: 4.5mmol/L (3.5 - 4.5 mmol/L) Calcium: 10.4 (8.1-10.4mg)
    •  Kidney functions test: Urea : 18 normal :(15-45mg %) Creatinine: 0.7 normal(0.3-1.3mg %) Liver functions test:  SGPT(ALT): 15 normal up to 45u/ml.  SGPT(AST): 39 normal up to 40 u/ml.  S. bilirubin :  total : 5.5 normal up to 1.2n.g  direct: 0.8 normal up to 0.25n.g
    •  Marked hepatomegally with diffuse increased parenchymal density Conclusion: signs suggestive of diffuse parenchymal liver disease for lab.correlation&biopsy.
    • CT brain was ordered because of association of central abnormalities with cases of neonatal hyperglycemia
    •  Large defined cystic lesion of c.s.f density is seen at RT. Tempro-parietal region connected to the atrium of the rt. Lateral ventricle It is seen surrounded by mild degree of interstitial oedema (csf permeation) It measures about 4x3.5 cm.
    •  No evident related soft tissue masses. It exerts mild mass effect in the form of compression upon the third ventricle &minimal leftward shift of the mid line structuresConclusions:Signs cope with large RT.tempro- parietal proncephalic cyst.
    • Neurosurgical consultation:Supratentorial arachnoid cyst attached to the RT. Lateral ventricle &effaced if less likely (pitocyst-AC)for M.R.I&contrast M.R.I Brain :The same finding as C.T.
    •  8 days after admission, the baby starts to develop subtle convulsions in the form of (pedaling & recycling ) alternating with tonic clonic convulsions of both upper limbs ,respond to phenobarbitone . In addition to 3 attacks of generalized tonic clonic convulsions associated with hypoglycemia as a complications of insulin infusion respond rapidly to I.V. GL. 10%
    • Respiratory: C.P.A.P by nasal bronge with pressure 5 mm.Hg, oxygen 21% for 3 days. The baby was Shifted to H.B. 5L/min.for 1 day. Antibiotics : Unictam+cefatriaxone for 7 days followed by Vancomycin +gentamycin Nebulizer with ventolin
    • Glucose : We start with GL.10%with Na &K&Ca , Then reduce gl. concentration to 7% and then to 5%. We modulate G.I.R according to results of blood glucose starting with 7mg/kg/min. till 5.5 mg/kg/min. A.A (panamin g. 0.5 gm./kg/day) lipids (lipovenous 0.5 gm./kg./day)
    •  With persistent hyperglycemia even with G.I.R 5.5mg/kg/min. we start insulin infusion in a dose of 0.02 u/kg/hour. in spite of this minimal dose of insulin the baby developed hypoglycemia so we have to increase G.I.R to 7.5 mg/kg/min. with insulin infusion till stabilization of blood glucose
    •  With stabilization of the baby ,we start gradual nasogastric feeding followed by complete oral feeding . As soon as oral feeding is completed blood glucose returns to normal values.
    •  Blood transfusion :15 ml./kg. Plasma transfusion :15 ml/kg. I.V. phenobarbitone followed by oral phenobarbitone. Surgical drainage of cyst &CSF by shunt operation.
    • After shunt Before shunt