Febrile 125: A Critical Query
Nov 17, 2025
Dr. Raghad Al-Abdwani, a pediatric intensive care consultant, joins Dr. Badriya Al Adawi, a medical microbiologist, and Dr. Zaid Al Hinai, head of pediatric infectious diseases, to discuss a challenging case of a critically ill child. They cover the complex decision-making behind diagnosing severe infections, such as Q fever, emphasizing the importance of interdisciplinary collaboration. Topics include initial management strategies, targeted microbiology testing, and the nuances of sickle cell disease in the context of infectious diseases.
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Critical Presentation And Rapid PICU Resuscitation
- A four-year-old boy with sickle cell presented in shock with hemoglobin 2.3 g/dL and severe lactic acidosis.
- The PICU team rapidly transfused small aliquots, intubated, and provided targeted resuscitation to stabilize him.
Laboratory Clues Point To Hepatic Sequestration
- Labs showed hemoglobin 2.3, AST 4,200, ALT ~1,000, INR 1.6, CRP ~350 and lactate 22.
- These findings pointed to severe hepatic involvement plus shock, suggesting hepatic sequestration or fulminant hepatitis.
Reassess Exposure History Early And Often
- Ask about exposures: animals, farms, unpasteurized dairy, travel, ticks, and water sources when hepatotropic infections are suspected.
- Revisit history repeatedly if clinical course is atypical or not improving.