Thursday, June 25, 2009

Sick in Soleil


This is 8 month old Davison.

When I walked into clinic this morning the nurses already had an IV in her left foot. Her parents were in the office with her and gave this history:

Baby Davison started vomiting yesterday morning and had also many episodes of diarrhea. By this morning she was very dehdyrated. Her parents took her to the local hospital at 8 AM but found no medical personnel available to help her.

So the parents rushed her to our pediatric clinic just one hundred yards away.

When I examined Baby Davison her eyes were sunk but she was crying and would avidly take Oral Rehydration Solution (ORS) from the syringe when we offered it. Davison's skin was hot and dry and her heart rate was too fast to count. Her breathing was slightly labored.... but could have been due to her distended abdomen.

The IV "blew" in the left foot and so I continued the oral rehydration. I also gave her an injection of ceftriaxone in her right thigh. She didn't cry or budge during the injection which was not a good sign.

Baby Davison then had twitching of her legs and arms and she looked to the right. Her cool hands became tight fists squeezing her thumbs hard. These seizures happened frequently over the next 15 minutes.

However, when she came out of these spells, she looked dazed, and would start taking fluid again by mouth. Her blood glucose could have been low or she could have had another electrolyte abnormality with or without sepsis or meningits.

I rolled her on to her right side and tapped her back because her abdomen was becoming more enlarged and tight and she quit crying.

Baby Davison then vomitted all of the ORS on to the exam table. But she kept breathing.

And so we started over with the ORS between seizures.

Our clinic director came in and said that the Hospital close by now had medical staff, and so we dressed Baby Davison and her father picked her up. (Her mother had been seated behind us from sheer exhaustion and her intuition regarding Davison's situation.)

They hurried out of the room after I wrote a quick referral note. We told the parents to keep giving the ORS if they needed to wait in line to be seen.

Another morning in Soleil and another baby failed by poverty.
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