Approach to hypotonia (newborn and infant) Quiz: Ace Your Exams
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A 9-month-old girl is brought to the emergency department for evaluation of poor sucking, difficulty feeding, and lethargy for the past three hours. The caregiver reports feeding the infant honey last week. There is no history of fever, rash, vomiting, or seizures. Immunizations are up to date. Birth, medical, and family histories are unremarkable. Development is appropriate for age. Temperature is 36.8°C (98.2°F), pulse is 110/min, respirations are 57/min, blood pressure is 77/42 mm Hg, and oxygen saturation is 87% on room air. The infant exhibits symmetrical hypotonia, diminished sucking, and drooping eyelids. Increased work of breathing with grunting is noted. Laboratory results are shown below. Which of the following is the best next step in management?
| Capillary blood gas | |
| pH | 7.32 |
| PCO2 | 58 mmHg |
| PO2 | 60 mmHg |
| HCo3 | 22 mEq/L |
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