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• W2334939842 abstract "1. Elizabeth Chuang, MD, MPH*2. Celia Ng, RN†3. Jacqueline Ehrlich, MD, MPH† 1. *At the time this article was written, Dr Chuang was a resident at the New York City Department of Health and Mental Hygiene. She is currently with Montefiore Medical Center Palliative Care Service, Bronx, NY.2. †New York City Department of Health and Mental Hygiene, Bureau of Environmental Disease Prevention, Lead Poisoning Prevention Program, New York, NY.A 47-month-old girl with sickle cell disease presents to the emergency department with decreased oral intake and abdominal pain for 3 days. She was diagnosed as having sickle cell disease at age 2 years and had 4 previous hospitalizations for sickle cell crisis. Current medications include oral folic acid, 5 mg/d, and penicillin weekly. Review of systems reveals a history of constipation. The patient and her family moved to the United States from Angola more than 2 years ago.She is in no distress. Her blood pressure is mildly elevated at 121/75 mm Hg, her heart rate is 99 beats per minute, her temperature is 96.8°F (36°C), and her respiratory rate is 24 breaths per minute. She has normal bowel sounds and a soft, nontender abdomen with no organomegaly. The rest of her physical examination findings are unremarkable. Laboratory testing reveals the following: hemoglobin, 8.7 g/dL (87 g/L); platelets, 186 × 103/μL (186 × 109/L); white blood cell (WBC) count, 21,000/μL (21 × 109/L), with 55% neutrophils, 24% lymphocytes, and 10% monocytes; serum aspartate aminotransferase (AST), 112 U/L (reference range, 5-40 U/L); alanine aminotransferase (ALT), 77 U/L (reference range, 7-56 U/L); and alkaline phosphatase, 159 U/L (reference range, 30-120 U/L). An abdominal radiograph is interpreted as “normal” by the emergency department (Figure 1). The urinalysis result is positive for leukoesterase with 3 to 5 red blood cells per high-power field, 30 to 50 WBCs per high-power field, some WBC casts, and large bacteria.Figure 1. Abdominal flat plate read as normal.The patient is admitted for a presumed urinary tract infection and treated with ceftriaxone …" @default.
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• W2334939842 date "2013-09-01" @default.
• W2334939842 modified "2023-10-14" @default.
• W2334939842 title "Visual Diagnosis: Girl With Sickle Cell Disease, Abdominal Pain, and Elevated Blood Pressure ... A Missed Opportunity" @default.
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• W2334939842 doi "https://doi.org/10.1542/pir.34-9-e31" @default.
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