你好!我是在香港的.我本身是香港一名家庭医生. 幸運地我的好友是一位对KD又好高警覺性的兒科医生!我也找了香港对KD很有experience的吳彦明医生(你認識他嗎?)
just want to share with other people so doctors won't miss the disease (KD) again.
"曰本地震,核爆危機,都已不重要了!”
(sorry for my english/ chinese writing)
3月11日,Day 1
曰本地震海嘯! 同曰我22個月大BB病了!
我本身是一位家庭医身,BB發燒我不怕，給了退燒藥&抗生素,再看看。
Day 2
發燒continued. 繼續吃藥看看。BB精神還好! 到深夜，又發高燒，有點咳，给他洗澡to lower the temp. 發現BCG scar 有很少的紅点(！！！this was not mentioned in medical textbook before when i was in medical school)
Day 3
早上燒退了。但到中午又發高燒+嘔，心想有点不对,跑到医院找兒科舊同學看看。眼紅, 有lymph node. 看似adenovirus. 抽了nasopharyngeal aspirate ,照了chest x ray . x ray normal 便回家了。
Day 4
situation still the same. 無胃口,眼紅,口紅。nasopharyngeal aspirate negative. 手脚沒有紅疹。
Day 5
still 吃不下,發燒但不很高。再到另一兒科舊同學辦事医院看。抽了血,吊drip. give iv fluid 後大半天沒有發燒·BB看似精神一点· 怎知以為快可回家时, 舊同學急忙入来说要照echocardiogram. suspect kawasaki's disease.because ESR very high. 我已慌得不懂解釋給丈夫聽。只會急忙给BB吃藥去照echo.
echo normal.......
it's a case if suspected Atypical KD! No sufficient criteria for diagnosis.
Deep down i hope it was not KD. But actually i already believed it is. However there are not enough criteria for IVIG, and fever was down .........so my paediatrician friend said the only thing was we have to 'wait and see'
My paediatrician friend was in a dilemma too becuase we both know the consequence of NOT giving IVIG is big.. however.. we don't want to overtreat, as IVIG got risk too... so.. what a dilemma
We went home to rest
Day 6
I found another paediatric cardiologist (dr Ng) , very experienced paediatric cardiologist in hk about KD. he saw the results and the condition. echo done.. still cannot make the diagnosis. But Dr Ng said if the fever subside by itself on day 5, echo normal, there is no need for IVIG. because some KD will subside by itself and the risk for anerysm is low. (that's a relief to me)
Day7
BB still no apetite and looked tired. He looked very miserable to me (that's mother's instinct)... and in evening.. i picked up a low grade fever 37.8 (dunno it's good or not), Rushed back to hospital to repeat blood tests. at midnight........... platelet raised! confirmed Atypical KD. Finally we got enough criteria..
Day 8
Admited and gave IVIG... Fever finally subsided. Actually he got no high fever since day 5
Clinically he looks much better after IVIG
Day 10
discharged
In those days......... even i am a doctor........... i was so panic and need reassurance from different friends. Luckily i found your blog and my paediatrician friend really got the high index of suspision of KD.
Repeat echo in 2 weeks, still some inflammation in coronary arteries but no dilitation. platelet still high so need aspirin.
repeated bld tests at 8weeks. bld tests and echo normal.
這是給每一位川崎守護天使最好的禮物！非常感謝每一位幫助過我們的医護人員及朋友!多謝!
Nothing is important when your own BB is sick. He/She sure is the most valuable thing in life for you.
But as 郭医師 said... treating this disease needs to be ..."治療要耐心,然後别擔心,最後一定會放心!
i want to share with you about my atypi
cal case. so drs won't miss the diagnosis and treatment.
best wishes,
winnie from Hong Kong.
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