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Hypernatremic dehydration, malaria and septicaemia
complicated by peripheral gangrene in infancy. Case Report A female infant of 53 days referred from Dondo district hospital, was admitted there with fever, diarrhoea and vomiting. She stayed 6 days on investigations and test for malaria came positive for Plasmodium falciparum. Treatment started with iv Quinine. The child’s condition was deteriorating and both lower limbs got discoloured/blue. Two days after, the infant was transferred to Beira Central Hospital. The infant was critically sick with high fever an bilateral lower limb up to mid leg was gangrenous. On investigation she had Hgb 6.2, RBC 2.51, WBC 26.200, neutrophil 63%, Lymphocytes 35%, Monocytes 2%, PLT 113.000, Na+ 170mmol/I, AST 104, ALT 102, Total Protein 38, Albumin 18. Thorax x-ray shows bilateral lobar pneumonia. She started treatment with iv fluids, antibiotics Ampicillin and Gentamycin and iv Quinine. After 3 days of treatment, she shows improvement in general condition, laboratory investigation comes towards normal and limbs show only superficial gangrene, but the toes show dry gangrene. A review of the literature revealed 10 infants who had hypernatremic dehydration (HD) and gangrene of the extremities. This combination could occur because of hypoperfusion and sluggish blood movement due to hyperviscosity, which coexist in HD, resulting in a disturbed microcirculation, combined with strain-specific parasite factors, (tissue sequestration of mature forms, rosette formation), may predispose to peripheral microvascular occlusion, sufficient to produce infarction of tissue in susceptible children. A revision of this rare pathology is made and the final outcome is described. |
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