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📋 Ward Case List - Detailed Diagnoses

🏥 PAEDIATRIC WARD

1. Miss. Lakshara | 2Y/F | Reg: 26030272

Diagnosis: Citronella Ingestion (Mosquito Repellent Stick Ingestion)

Citronella is a plant-derived essential oil used in mosquito repellent products. Ingestion in toddlers is a common accidental poisoning.

Key Clinical Features:

Oral/mucosal irritation, drooling, nausea, vomiting
Aspiration risk - citronella is a hydrocarbon-based oil, so the main danger is chemical aspiration pneumonitis if vomited and inhaled
CNS effects: lethargy, drowsiness in significant ingestion
GI upset: abdominal pain, diarrhea

Management:

Do NOT induce vomiting (aspiration risk)
Supportive care - monitor respiratory status closely
Chest X-ray if any respiratory symptoms develop
Observe for 4-6 hours minimum
Activated charcoal generally not recommended for hydrocarbons
Most cases are mild and self-limiting with supportive care

2. Miss. Yazhini | 6Y/F | Reg: 26030118

Diagnosis: ADA Deficiency (Adenosine Deaminase Deficiency)

ADA deficiency is a rare autosomal recessive metabolic disorder and one of the most common causes of autosomal recessive Severe Combined Immunodeficiency (SCID).

Pathophysiology:

ADA enzyme normally breaks down adenosine and deoxyadenosine
Deficiency leads to accumulation of deoxyadenosine and dATP - toxic to lymphocytes
Results in severe depletion of T cells, B cells, and NK cells (~15% of all SCID cases)

Clinical Features:

Recurrent/severe infections from infancy (bacterial, viral, fungal, opportunistic)
Failure to thrive
Lymphopenia on CBC
May have skeletal abnormalities (rib cage, spine)

Management:

Enzyme Replacement Therapy (ERT): PEG-ADA (pegademase bovine)
Hematopoietic Stem Cell Transplant (HSCT) - potentially curative
Gene therapy (approved in some centers)
Prophylactic antibiotics, antifungals, antivirals
IVIG supplementation
Live vaccines are contraindicated

3. Mas. Logith | 5Y/M | Reg: 26030153

Diagnosis: Not documented in notes

No diagnosis recorded for this patient in the ward list.

4. Miss. Sudhiksha | 7Y/F | Reg: 26030146

Diagnosis: Fever

Fever in a 7-year-old is a symptom requiring further workup for the underlying cause.

Common Causes to Evaluate:

Viral URTI / Influenza
Bacterial infection (UTI, pneumonia, tonsillitis)
Dengue fever (endemic concern in South India)
Malaria
Enteric fever (Typhoid)

Workup:

CBC with differential, ESR, CRP
Blood culture if sepsis suspected
Urine routine and culture
Widal/Dengue NS1 antigen + serology as clinically indicated
Chest X-ray if respiratory symptoms

Management:

Antipyretics: Paracetamol 10-15 mg/kg/dose
Adequate hydration
Treat underlying cause once identified

5. Miss. Harshika | 2Y/F | Reg: 26030154

Diagnosis: Cervical Lymphadenitis

Inflammation of cervical lymph nodes, common in young children.

Most Common Causes:

Bacterial: Staphylococcus aureus, Streptococcus pyogenes (most frequent)
Viral: EBV (Infectious mononucleosis), adenovirus, CMV
Mycobacterial: TB lymphadenitis (scrofula) - important differential in endemic areas
Kawasaki disease (consider if fever >5 days + other features)

Clinical Features:

Swollen, tender lymph nodes in the neck
Fever, overlying skin erythema (in bacterial)
Fluctuance suggests abscess formation

Management:

Bacterial: Oral amoxicillin-clavulanate or cloxacillin for 10-14 days
If abscess: Surgical I&D + antibiotic coverage
Tuberculosis: 4-drug ATT (HRZE) for 2 months, then 2-drug maintenance
USS neck to differentiate reactive nodes vs abscess vs suppuration

6. Miss. Dhanushei | 7Y/F | Reg: 26030128

Diagnosis: Abdominal Pain

Recurrent or acute abdominal pain in children requires systematic evaluation.

Common Causes in School-Age Children:

Functional abdominal pain (most common cause)
Constipation
Mesenteric adenitis
Appendicitis (must rule out)
UTI / urinary tract pathology
Worm infestations (ascariasis)
Intussusception (less common at 7 years)

Workup:

Abdominal examination (guarding, rebound, Rovsing's sign)
CBC, CRP, urine routine
Stool for ova and parasites
Abdominal ultrasound
Appendicular tenderness - Alvarado score

7. Miss. Tamizhini | 3Y/F | Reg: 26030160

Diagnosis: Not documented in notes

No diagnosis recorded for this patient in the ward list.

8. Miss. Yashwitha | 8Y/F | Reg: 26029819

Diagnosis: ? Nephrotic Syndrome

Suspected nephrotic syndrome - the "?" indicates it is a working/provisional diagnosis.

Diagnostic Criteria (Nephrotic Syndrome):

Massive proteinuria: >40 mg/m²/hr or urine protein:creatinine ratio >2
Hypoalbuminemia: Serum albumin <2.5 g/dL
Edema: Periorbital (especially morning), pedal, ascites
Hyperlipidemia: Elevated total cholesterol

Most Common Cause in Children:

Minimal Change Disease (MCD) - ~80% of childhood nephrotic syndrome; highly steroid-responsive

Workup:

Urine dipstick (3+ to 4+ proteinuria), spot urine protein:creatinine ratio, 24-hr urine protein
Serum albumin, cholesterol, creatinine, electrolytes
Complement levels (C3, C4)
Renal ultrasound

Management (ISKDC Protocol):

First-line: Prednisolone 2 mg/kg/day (max 60 mg/day) for 4 weeks, then alternate day for 4 weeks
Salt restriction, fluid management for edema
Albumin infusion + furosemide for severe edema/anasarca
Monitor for infection (spontaneous bacterial peritonitis risk)
Pneumococcal vaccine recommended

👶 NICU (Neonatal ICU)

1. B/o Sandhiya | 4 Days/F | Reg: 26029917

Diagnosis: Feeding Difficulty (No Sucking)

Causes of Poor Sucking Reflex in Neonates:

Prematurity (immature suck-swallow coordination)
Hypoxic Ischemic Encephalopathy (HIE)
Sepsis/meningitis
Metabolic disturbances (hypoglycemia, hypocalcemia)
Hypothyroidism
Neuromuscular disorders (rare)

Assessment:

Birth history, gestational age, APGAR scores
Full sepsis workup if indicated
Blood glucose monitoring
Neurological examination

Management:

Nasogastric (NG) tube feeds / orogastric feeds
Monitor for adequate intake and weight gain
Lactation support
Treat any underlying cause identified

2. B/o Charumathi | 1 Day/F | Reg: 26028424

Diagnosis: Very Preterm - Low Birth Weight (LBW)

"Very preterm" is defined as gestational age < 32 weeks.

Key Issues to Monitor:

Respiratory Distress Syndrome (RDS): Due to surfactant deficiency - may require CPAP/mechanical ventilation and exogenous surfactant
Hypothermia: Incubator/radiant warmer care essential
Hypoglycemia: Frequent blood glucose monitoring
Feeding intolerance: Start minimal enteral feeds with breast milk when stable
Intraventricular Hemorrhage (IVH): Cranial USS screening
Retinopathy of Prematurity (ROP): Ophthalmology screening
Necrotizing Enterocolitis (NEC): Vigilance for abdominal distension, bloody stools
Jaundice: Phototherapy threshold lower in preterm

Management:

NICU incubator care (neutral thermal environment)
Respiratory support as needed (Surfactant therapy if RDS)
TPN / IV fluids progressing to enteral feeding
Kangaroo Mother Care (KMC) when stable
Antibiotic cover if sepsis suspected

3. B/o Divaya | 1 Day/F | Reg: 26029446

Diagnosis: Severe Birth Asphyxia

Definition: Failure to initiate or sustain spontaneous breathing at birth, resulting in hypoxia, hypercapnia, and acidosis.

Severity Classification (Sarnat & Sarnat / Thompson Score):

Severe: APGAR ≤3 at 10 minutes, arterial pH <7.0, base deficit ≥16

Resulting Condition - Hypoxic Ischemic Encephalopathy (HIE):

Encephalopathy: seizures, altered tone/consciousness, poor feeding
Multi-organ involvement: heart, kidneys, liver, gut, lungs

Gold Standard Treatment - Therapeutic Hypothermia (Cooling):

Criteria: ≥36 weeks gestation, <6 hours of age, evidence of HIE
Core body temperature maintained at 33-34°C for 72 hours, then gradual rewarming
Reduces neuronal death by slowing apoptosis cascades
Proven to reduce death and severe neurodisability (NNT ~6-9)

Additional Management:

Seizure control: Phenobarbital first-line
Glucose management: Avoid hypoglycemia AND hyperglycemia
Fluid restriction initially (risk of SIADH, renal failure)
Monitor for multi-organ dysfunction
EEG monitoring (continuous if available)
MRI brain at 3-5 days to assess extent of injury

Prognosis:

Severe HIE carries significant risk of cerebral palsy, cognitive impairment, epilepsy, or death
Early cooling therapy significantly improves outcomes

🏥 OBSTETRICS WARD (WhatsApp Message)

#	Name	Age	Procedure/Diagnosis	Notes
1	Charumathi	28F	Emergency LSCS	Urgent caesarean section - indication not specified (may include fetal distress, cord prolapse, failed induction)
2	Elaiya	24F	Emergency LSCS	Same as above
3	Kavitha	33F	Elective LSCS	Planned caesarean - common indications: previous scar, malpresentation, placenta previa
5	Divya	23F	Emergency LICS	Lower segment caesarean (likely LSCS - probable transcription error)
6	Divya Bharathi	32F	GDM	Gestational Diabetes Mellitus - diabetes diagnosed in pregnancy; managed with diet control, metformin, or insulin
7	SuriyaYamini	20F	Emergency LSCS	Urgent caesarean
8	Sandhiya	32F	Anemia Correction + GHTN	Gestational Hypertension - BP ≥140/90 after 20 weeks without proteinuria; being treated alongside iron deficiency anemia correction

GDM (Divya Bharathi): Target fasting glucose <95 mg/dL, 2-hr postprandial <120 mg/dL; risk of macrosomia, shoulder dystocia, neonatal hypoglycemia.

GHTN (Sandhiya): Monitor for progression to Pre-eclampsia (addition of proteinuria/end-organ damage). Antihypertensive if BP ≥160/110 (labetalol, nifedipine). Anemia correction via IV iron infusion or blood transfusion depending on Hb level.

Note: This is an educational clinical summary based on ward notes. Actual patient management should follow clinical examination findings, local protocols, and treating physician judgment.

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