Enteric fever with hypothermia, shock and myocarditis

A child of 6 years presented with 14 days fever and rt upper abdominal tenderness. He was lebelled as 'Enteric Fever' and admitted in hospital for parenteral medication(30/5/07). Among lab test, widal test was found positive. On the second day of hospital, he developed hypothermia and shock. Pt was transfered to critical care unit and managed. Pt recovered from hypothermia and shock after 48 hours of intensive manuevre with blood, fluid, dopamine, dulbutamine, nasogastric suction and oxygen. Ceftrixone was contuied but oral Azithromycin has to replaced with IV ciprofloxacin.

When the patient become stable and we were feeling a little relaxed, the patient developed respiratory distress and little puffiness of the face. We vealuate the renal funtions- his output was normal, serum creatinine and electrolytes was found normal.

On auscultation, pt had bilateral crepitaions and tender hepatomegaly. Pulse was 142/m, BP 105/70, Ultrasonograpgy of the abdomen was found normal. Xray shows mild pulmonary edema. Myocarditis with heart was suspected and pt improved after giving Inj Lasix and lasix prescribed for twice a day.

Pt's fever was persisting and oral Azithromyecin was added. But the patient develops hypothermia again in late hours of the day(5/5/07). To raise the temparature, blanket was used and pt was given steroid in Inj form. His pulse, BP,bowel was normal. So, is the hypothermia is a beacuse of toximia?Pt was also irritable and restless then.

By morning the patient become a bit settled, distress decreased and temparature normalised.

We are still fighting for the patient.(6/6/07). Not yet sure about the outcome.

Bdoza