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Pediatric Pearls: Dangerous Pediatric Fevers

Ilene Claudius, MD
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What are the big ticket items to consider when treating children with fever? You wanted to know and we wanted to know. Ilene shares her insights with us all. 

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Michael G. -

Saw an irritable 2 year old with petechia everywhere and some bruising on his shins, fever 104 last week. I worked him up fully, LP'd him, gave abx. Cbc comes back an hour and a half after the LP and his platelets were 8. I called the peds referral hospital and they said not to give platelets. Got a call hours later and the admitting docs were mad we did an LP.

Im just not sure what to do here. Do you wait 2 hrs for the CBC before the LP and delay treating? Just treat and delay the LP? Or just do it. Do you risk delay in dx and treatment of meningococcal disease, but in retrospect risk spinal hematoma from the LP? Obviously I took the just do it approach, fever, irritability, and head to toe dark purple petechia seems like a bad combination.

I'd love to know what the Peds EM folks would do in a similar situation in case this situation pops up again.

ilene c. -

I find that admitting docs always have something to Monday morning quarterback about, and I'm sure if you treated without the LP they would have been unhappy about that as well. Typically, I don't check platelets in every child prior to LP but if there is something like sepsis or petechiae that might indicate thrombocytopenia I will check. If I am worried, I treat empirically pending the CBC results and, if the platelets are low and I'm worried, I just treat the child presumptively without ever doing the LP. Sounds like a crazy case and a sick kid, though, and I'm guessing you improved their chances by getting antibiotics on board quickly.

Thomas S. -

Thanks for the case report MIchael and the comments Ilene! Really helpful!

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Episode 134 Full episode audio for MD edition 239:14 min - 99 MB - M4AEMRAP November 2012 Written Summary 2 MB - PDF