Do I Need to Be Alarmed?
Profile: Ten-year-old boy, Weight: 68 pounds Medical History: Diagnosed with asthma, autism, ADHD, developmental delays, moderate hypotonia, and seasonal allergies. Current Health Issues: Experiencing fever primarily during nighttime, a constant cough that prevents him from speaking without inducing coughing, and a runny nose. While he sleeps, the pulse oximeter indicates a heart rate of 124 beats per minute with oxygen levels between 91 and 92 percent. Prior to bedtime, his oxygen saturation was at 97 percent and his heart rate was approximately 150 bpm. We have directed his asthma management according to the red zone protocol, utilizing duo nebulizers every six hours and Albuterol every three hours. He is also on a course of prednisolone due to the severity of his symptoms. In addition to these issues, he has developed bacterial conjunctivitis, which is unrelated to the current respiratory illness. He has also been unable to have a bowel movement for about a month (consulting a gastroenterologist), and we are on the second attempt at a home-based bowel regimen, which is also not affiliated with his current health condition. I visited urgent care today because of the emergence of pink eye during this viral episode. The assessment showed clear lung sounds, and the medical staff deemed the condition as viral, showing no significant concern. Interestingly, his younger brother, aged four, has identical symptoms, although without pink eye. Additionally, their grandmother is exhibiting the same symptoms, and she too sought urgent care today, having contracted pink eye through contact with my son. Initially, I presumed the conjunctivitis was viral until I witnessed his swollen, gunky eye this morning. I understand that fever and medication can elevate heart rates. I personally experience inappropriate sinus tachycardia with occasional extra beats, which can become quite erratic. However, I worry that I may be projecting my anxieties onto him. We plan to reach out to the gastroenterologist tomorrow, albeit I’m unsure if any further measures will be taken while he’s unwell. Should I be genuinely concerned, or am I just over-analyzing the situation? He is currently asleep, coughing very little, but has some audible breathing sounds.
Answers (1)
3/31/2025, 3:50:45 AM
OpenHealth AI
It sounds like you're dealing with a complex situation involving your son's health, and it’s completely understandable to feel concerned given the combination of his symptoms. Key points to address are the persistent fever, asthma management, and respiratory symptoms, especially as they relate to his overall comfort and well-being.
Explanation
Your son exhibits several symptoms: a nighttime fever, a constant cough, and low oxygen saturation levels during sleep. These issues, combined with his diagnosis of asthma and seasonal allergies, can contribute to respiratory distress. It's a positive sign that urgent care reported clear lung sounds, indicating no immediate blockage or severe complications. However, the combination of coughing, elevated heart rate, and diminished oxygen levels may warrant ongoing monitoring, especially with his known asthma history and recent viral infection.
Even though coughs are often part of viral infections and can linger, the low oxygen levels (91-92%) and elevated heart rate (especially at bedtime) suggest that careful observation is necessary. Managing asthma during viral illnesses can be tricky, so maintaining his asthma protocol is crucial.
Next Steps
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Continue Monitoring: Keep regular checks on his pulse oximeter readings, especially during the night. If oxygen levels drop below 90%, he should be evaluated promptly.
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Asthma Management: Follow the prescribed asthma management plan diligently. Ensure that he continues receiving duoneb and albuterol as directed. If his breathing worsens or he struggles to speak due to coughing, consult your care team immediately.
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Hydration and Comfort: Ensure he remains hydrated, as this can help thin secretions and reduce cough. Use a humidifier in his room to ease breathing during sleep.
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Fever Management: Monitor his fever with a thermometer. If his fever exceeds 101°F (38.3°C) and persists despite medication, or if he appears in distress, it may be time to seek further evaluation.
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Follow-Up on Conjunctivitis: Given his bacterial conjunctivitis, ensure he's receiving treatment as prescribed, and keep an eye out for any signs of worsening or spreading.
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Bowel Concerns: Since you’re already consulting a gastroenterologist, continue to follow advice regarding his bowel regimen, but openly discuss any concerns that arise during this respiratory illness.
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Monitor Family Symptoms: Keep an eye on symptoms in your younger son and grandmother. If either develops fever or significant respiratory distress, seek medical advice.
Lastly, it's natural to feel anxious, especially as a caregiver. Avoid projecting your concerns onto your son, but trust your instincts. If things feel off or worsen, don’t hesitate to seek further medical guidance. You’re doing a fantastic job by staying vigilant and informed about his health.
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# 7-Month-Old Child with Abernethy Malformation - Exploring Treatment Options ## [7-Month-Old] Identified with Abernethy Malformation (Congenital Portosystemic Shunt) - Treatment Methods? **Age:** 7 months **Gender:** Female **Height:** Age-appropriate **Weight:** Currently 9 kg, was 2.8 kg at birth **Ethnicity:** Asian **Duration of Symptoms:** Present since birth **Location:** Uzbekistan **Pre-existing Health Issues:** Abernethy malformation (congenital portosystemic shunt), liver hemangiomas, chronic jaundice, anemia **Current Treatments:** Supportive management --- ## INITIAL PRESENTATION (June 2025 - July 2025) Our daughter arrived on **June 27, 2025**, presenting with: - Birth weight: **2.8 kg** - Marked jaundice (yellowing of skin and sclera) - Pale or clay-colored stools - **Bilirubin level: 245 μmol/L** (typically <20) An immediate ultrasound indicated multiple liver anomalies, initially thought to be hemangiomas. --- ## FIRST COMPREHENSIVE ASSESSMENT (August 1, 2025 - 1 Month Old) ### Multislice Computed Tomography (MSCT) with 3-Phase Contrast (August 1, 2025): **RESULTS:** - 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7 Months Old) - **Weight:** 9 kg (good growth rate in spite of condition) - **Jaundice:** Continues to be present (yellow skin) - **Stools:** Remain pale/clay-colored - **Development:** Achieving appropriate milestones - **Energy:** Appears to have a good energy level - **Feeding:** Normal appetite --- ## QUESTIONS FOR r/AskDocs We have been informed this is **Type 2 Abernethy malformation** (portal vein present). **Three treatment avenues have been proposed:** ### Option 1: **Endovascular Coil Embolization** (minimally invasive approach) - A catheter is inserted via the leg vein to access the shunt and deploy coils/plugs to close the abnormal vessels - Pros: No surgical incision, minimal discomfort, short hospital stay (2-4 days), no scars, enhanced safety - Duration: 1-2 hours - Recovery: 2-4 weeks for jaundice to show improvement ### Option 2: **Open Surgical Intervention** - An incision in the abdomen to ligate abnormal vessels and redirect blood to the liver - Pros: Direct visualization, effective results - Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.