This child has edema with evidence of feeding issues (difficulty feeding/poor growth) as a result of CHF. The increased HR and RR and abnormalities on cardia exam are further suggestive of this. The normal serum albumin, creatinine and urinalysis effectively rule out a renal cause of the edema.
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A 5 year old patient presents with her parent to the ER department with increasing eye and leg edema. The parent is also concerned by the child's poor growth. The patient is a poor feeder with normal urine output. Upon physical examination the patient appears unwell but not cyanotic and has a gallop rhythm. The liver appears 2cm below the costal margin. Labwork is as follows:
Urinalysis: negative protein and blood
Serum albumin: 34 g/L
Serum creatinine: 24 umol/L
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Authors
Dr. Gabriele Weiler
gweiler@cheo.on.ca
Dr. Joanna Holland
joanna.holland@iwk.nshealth.ca
Dr. Joanne Grimmer
joanne.grimmer@lhsc.on.caReviewers