[Hopefulheart]

On my ward there is a patient and the multi diciplinerary team has no idea what is wrong with her.

Female Age 11

Symptoms:low oxygen saturation,Temperature 39,Painful joints,Capilary refill time more than 4 seconds,Heart rate 112 per min,Hyper tension,Cold extremities

Has not been out of the country in the past 6 months

Lab results:

Every thing is normal except these three
Iron-Elevated
Low red blood cell count
Increased white blood count

Thanks if you have ever come across this

[sirI]

Hello, Hopefulheart and welcome to allnurses.com

I suppose that renal/endocrine disorders have been ruled out? Normally, a high percentage of hypertension in that age is secondary to renal disorders.

You didn't give any lab values, so not sure on the chemistries. What is the potassium value?

Has the child ingested licorice, chewing tobacco, or herbs?

Just throwing out some ideas here.....

[EricEnfermero]

No skin lesions? (Purpura, hives, etc?)

[Tweety]

Originally Posted by siri

You didn't give any lab values, so not sure on the chemistries. What is the potassium value?
.....

OP states all labs were normal...except those indicated.

I'm quite intrigued. Painful joints would coincide with high iron counts of hemochromatosis. But it doesn't quite fit.

[sirI]

Originally Posted by Tweety

OP states all labs were normal...except those indicated.

I'm quite intrigued. Painful joints would coincide with high iron counts of hemochromatosis. But it doesn't quite fit.

OP came back and edited the original post with the lab info about 30 mins. after I responded.

[perfectbluebuildings]

It sounds kind of like JRA? And possibly Raynaud's. I have a friend with both of these illnesses that has these s/s. The low o2 sat could be r/t poor circulation to extremities, if they are cold. Hope you all can find soemthing to help this pt!

[Hopefulheart]

Thanks for all your help!

Tjhe answer came from one of the most unlikely and unfortunate places places- her little sister got real unwell and it was only then we thought to do a lumbar puncture.My patient ended up getting tranferes to a hospital with a bigger PICU but the sister is at our PICU.It turned out it was slow onset bacterial menigitis.I cant believe we missed that but the symptoms where confussing.It could have been fatal .I feel so guilty for missing it.

[sirI]

Thank you for the update. Agree the s/s were atypical for meningitis with s/s decompensation and rather unique to MANY disease processess.

Glad they are doing o.k. now.