Wow!!!

Currently on the floor at Chicago Hope Hospital is a 5 year-old with listeria meningitis. That is incredibly rare!  Dr. House eat your heart out.

Buffering...buffering...buffering...

Cashier: "Sir, would you like your pop in the bag?"
Me: blank stare. "I'm sorry?"
Cashier: "Your pop, would you like it in the bag or do you want to just hold on to it?"
Me: Another blank stare. Oh!!! Pop = coke. "I'll just hold onto it thanks."
...bear with me folks. "Pop" does not compute yet. Nobody uses that term in the South. It's such a Midwestern thing.

Doctorese babble -- Failure To Thrive

FTT

   1.     Definition

a.     Crossing two percentile lines vertically or horizontally – 5^th and 95^th are 2 STDs

b.     Weight drops first, then height follows – if HC drops  pathological

c.     Also if Consistently below 3^rd percentile or 80^th percentile on weight vs. height

d.     Premies should be age-corrected up to two years

   2.     Causes

a.     Achondroplasia

b.     Trisomy 21

c.     GH deficiency

                                               i.     Williams’

                                             ii.     Turner’s

                                            iii.      

d.     Nutrition

                                               i.     1 oz = 30mL

                                             ii.     Should be getting 100ml/kg/day

                                            iii.     4 kg = 400mL/8 = 50mL = 1.5 oz q8hr

                                            iv.     Normal 60-80 kcal/day – Enfamil = 20kcal/oz

                                             v.     Premies/FTT/SGA/Withdrawal/Heart defects /Fast metabolism/ short bowel/ malabsorption all require increased energy needs -- 24 kcal/oz – can sometimes result in diarrhea -- discharge with Enfacare = 22kcal/oz

   3.     Inorganic

a.     Non-pathological – zero nutrition

b.     Observe a feeding

c.     15/min breast

d.     MCC of non-accidental abuse -- neglect

   4.     Organic

a.     Decreased food

                                               i.     TEF

                                             ii.     Pyloric stenosis

                                            iii.     Cleft palate/lip – special nipple

                                            iv.     Pierre Robin’s Sydrome

                                             v.     Oral-motor dysfunctions

b.     Increased metabolism

                                               i.     CHD

                                             ii.     Malabsorption syndrome

1.     Celic

2.     CF

                                            iii.     Short-bowel

                                            iv.     Small L-colon

                                             v.     Lactose intolerance

1.     Soy milk

2.     Galactosemia -- increased bilirubin

                                            vi.     Milk protein allergy – Neosure and Neoko? – rash/hives/diarrhea/melena

                                          vii.     Milk protein intolerance – only bloating and discomfort

c.     Increased excretion

d.     blaj

   5.     Infection

a.     IUGR – ToRCH -- symmetrical SGA

b.     Candida

c.     HIV ***

d.     Any other infection

   6.     Metabolic conditions

a.     Anion gap metabolic acidosis

b.     Neurological symptoms 

   7.     Neurological disorder

   8.     Lead toxicity – testing at 9 months

a.     Anemia

b.     Basophilic stippling

c.     Constipation

d.     Dust is MC source

e.     Screaming is capillary stick

   9.     Hg poisoning à fish 

   10.  Renal tubule acidosis

a.     Distil tubule

b.     Proximal tubule -- lost water and proteins – do UA  

   11.  ARPKD

   12.  Renal agensis

   13.  Reflux à hydronephrosis -- especially boys

   14.  Endocrine

a.     Hypothyroidism

                                               i.     Macrogloassia impedes swallowing

                                             ii.     Impacts metabolism

b.     Hypothalamus

   15.  Evaluation

a.     Watch a feeding

b.     Newborn screen

c.     Growth chart

d.     CMP/BMP – CBC (Infection) – glucose

e.     UA

f.      Pb

g.     HIV

h.     ToRCH titers

i.      Pre-ablumin – good indicator of feeding

   16.  Treatment

a.     Normal food à catch-up 100-120 kcal/kg -- 120ml/kg replacement – replace slowly

                                               i.     Refeeding syndrome – decreases PO4

                                             ii.     < 6 mo à increase 10-20g/day weight – weigh without diapers on the same scale at the same time

Today's Spanish lesson

"Sopla del corazon" = heart murmur.

A little extra hitch in my giddy-up...

While wearing my short white coat, walking from the cafeteria a receptionist I'd never seen before said, "Oh hello doctor!"

Ma'am, your child is fine. You, on the other hand...

Mrs. Bonkers: "I'm concerned my daughter isn't growing. She had cancer in her spine (which is gone) and now she's two inches shorter than all the kids in her class. They all started the same height in kindergarten. I mean I don't WANT her to be shorter than all the kids in her class. I mean look at her, she's almost 8 and only FOUR FEET TALL"

Me: "Let's check her charts. She's within the normal range for her weight and height for her age."

Mrs. Bonkers: "But I don't want her to be normal I want her to be fine."

Hmmm, which one of us would need the Xanax more...

Another QODD

"I was watching a French movie once, and it was all in French." They usually are bud :p. It drove me nuts.