1 death of severe hand, foot and mouth disease combined with acute necrotised enteritis

(Patient Age) : 2(Gender): Male(Department): Paediatric2 years old 8 months, fever, mental disorder 4d, 1d"Past History" children admitted to the hospital 4d no obvious causeof fever, body temperature up to 38.8 degrees C, mental disorder, spray non-spit vomiting, in the local clinic, the disease Before admission 1D children appear drowsiness, jumping, double eyelids, before admission 2h again in the local hospital, found that the child's foot rash (rash time parents can not be described),diagnosisas "severe hand, foot and mouth disease, viral encephalitis", to give physiological saline expansion, glycol and psilocybin pressure, milin, benzene barbimy after the transfer to my hospital"Drug Allergy History" NoPhysical Examination) Body temperature 37.9 degrees C, breathing 29 times/min, heart rate 137 times/min, blood pressure 112/62mmHg (1mmHg - 0.133kPa)Sleepy, foot bottom, foot back visible scattered in red grain-like papulesEyes are staring up, double-sided pupils and other large isospheres, about 2mm in diameter, sensitive to light reflectionHerpes was not seen with blood in the pharynxDouble lung breathing sound coarse, unheard and al-sounding, strong heart tone, rhythm, no murmurAbdominal soft, not included in the package, liver, spleen is not bigDeep-light reflections exist, meninges stimulate negative, two-sided pasteurization negativeThe limb end is slightly cooler, the capillaries blood vessels fill time 3s : Blood routine: white blood cell 21.84 x 109/L, neutrophil 0.758, hemoglobin 117g/L, platelet 332 x 109/L, C reactive protein 4.7mg/L Calcitonin-based 0.11?g/L Liver and kidney function, myocardial enzyme sesame is normal Cell immune , body fluid immunity, clotting four, fibrin degradation, D-dipolymer normal Pharynx swabs Kosachi virus group 16 (coxsackievirus A16, CA16) nucleic acid positive, enterovirus 71 (humanenterovirus 71, EV71) nucleic acid negative Stool specimens sent to Shenzhen Disease Prevention Center for Disease Control and Control tested for CA16 nucleic acid positive, EV71 nucleic acid negative Chest X-rays show an increase in double lung texture Electrocardiogram sinus tachycardia The blood flow rate of the blood vessels at the bottom of the skull was in the normal range, and the blood vessel throbbing index of the vertebral-base artery increased Blood gas analysis: pH7.342, PCO256.5mmHg, PO2134mmHg, BE5mmol/L, HCO3-30.6mmol/L, Blood Sodium 137mmol/L, Blood Potassium 2.9m/L, Ion Calcium 1.14m/Lmol, Blood sugar 5.9m/L Non-invasive displacement indicates that the heart index and peripheral vascular resistance index are basically normal (Pictures and Pictures): (Diagnosis): Hand, foot and mouth disease combined with acute necrotised enteritis after admission to the hospital to be libavirin antiviral, glycol reduction, propylene globulin 1g / (kg.d) and methyl strong pine dragon 2mg / (kg.d) anti-inflammatory, milin strong heart to improve microcirculation, potassium supplementation treatment After admission to the hospital 15h children nasal-fed milk gastric retention accompanied by non-jet-like vomiting, to fast, body: body temperature 38.3 degrees C, heart rate 137 times / min, breathing 20 times / min, transverse blood oxygen saturation 98%, blood pressure 125/70mmHg, shallow coma, shallow respiratory table accompanied by irregular rules of salivary, lung hearing and luo, abdominal soft, intestinal weakening Review blood gas analysis PCO260.3mmHg, BE8mmol/L, blood potassium 4.1mmol/L, blood sugar 7.3mmol/L, remaining basically normal Immediately to the trachea intubation ventilator auxiliary ventilation, trachea catheter not seen white and pink foam sputum Admitted to the hospital 36h children heat retreat, deep coma, two-sided pupils and other large isometers, diameter 3mm, loss of light reflection, heart rate 170 to 180 times / min, blood pressure 87/36mmhg, central vein pressure 6 to 12cm H2O (1cm H2O - 0.098kPa), fasting blood sugar 5.1mol /L, wet and cold limbs Stop milinon and maintain blood pressure with quick rehydration and vascular active drugs (adrenaline, dopamine) Admission 40h gastrointestinal decompression led to the outflow of 250 ml of yellow-green bile-like substances, followed by the emergence of coffee grounds-like substances, bloating with abdominal muscle tension, heart rate reduced to 130 times / min, blood pressure 78/35mmHg Blood gas analysis: pH7.198, PCO250.8mmHg, PO271mmHg, BE-8mmol/L, blood sodium 128mmol/L, blood sugar below the detection limit Give 10% glucose static push, physiological saline expansion, omeprazole inhibit stomach acid, 3% sodium chloride reduced cranial pressure After 1h retest blood sugar 2.7mmol/L The child's gastrointestinal decompression leads to the outflow of dark red blood matter, the whole body is cold, the skin color is gray, bloating and abdominal muscle tension is more obvious than before, the intestinal sound disappears, no stool Rapid patting bedside abdominal tablets show the accumulation of gas in the liver area; intestinal wall gas build-up, necrotised enteritis may be (Figure 1, 2) After consultation, the surgeon pointed out that the blood build-up of the child's vassal system is very obvious, and many suspicious intestinal wall gas build-up, combined with its clinical symptoms and abdominal signs, can be diagnosed as acute necrotised enteritis Consider the child's vital signs are unstable, not suitable for surgery, recommend conservative treatment, to merobinan anti-
infection , dynamic review of abdominal tablets After 2h, the heart rate and blood pressure of the child, immediately give the chest heart pressure, adrenaline push, to the parents to explain the condition, parents give up rescue, the child died "Death Diagnosis" (1) Acute necrotized enteritis; (2) severe hand, foot and mouth disease; and (3) viral encephalitis Source: Network