Henry, a 2.5-year-old boy, presented with a 4-day history of fever and cough. He had been seen by a general practitioner and was prescribed oral antibiotics and antipyretics. On the morning of admission, he developed shortness of breath and was brought to the hospital. On examination, he was febrile with a temperature of 39.7 °C, appeared pale and exhibited marked subcostal insucking with a respiratory rate of 72 breaths per minute. Chest auscultation revealed reduced air entry over the right lung field, accompanied by stony dullness on percussion. An urgent chest X-ray confirmed right-sided pneumonia with significant pleural effusion. Laboratory investigations showed a haemoglobin level of 6.9 g/dL, a platelet count of 18 × 109/L and an elevated white cell count of 20.1 × 109/L, which was neutrophil predominant. Renal function tests revealed an elevated urea level of 10.7 mmol/L and a creatinine level of 143 μmol/L. What would be your next steps in managing Henry?

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Pneumonia Beyond the Lungs

  • Manson Chon In Kuok

摘要

Henry, a 2.5-year-old boy, presented with a 4-day history of fever and cough. He had been seen by a general practitioner and was prescribed oral antibiotics and antipyretics. On the morning of admission, he developed shortness of breath and was brought to the hospital. On examination, he was febrile with a temperature of 39.7 °C, appeared pale and exhibited marked subcostal insucking with a respiratory rate of 72 breaths per minute. Chest auscultation revealed reduced air entry over the right lung field, accompanied by stony dullness on percussion. An urgent chest X-ray confirmed right-sided pneumonia with significant pleural effusion. Laboratory investigations showed a haemoglobin level of 6.9 g/dL, a platelet count of 18 × 109/L and an elevated white cell count of 20.1 × 109/L, which was neutrophil predominant. Renal function tests revealed an elevated urea level of 10.7 mmol/L and a creatinine level of 143 μmol/L. What would be your next steps in managing Henry?