Sepsis (pediatrics) Quiz: Ace Your Exams

A 4-year-old boy presents to the emergency department with his parents for evaluation of a fever. Parents state the patient suffers from recurrent urinary tract infections (UTI) due to duplication of the collecting system and are concerned that he may have another UTI. The patient does not have a cough, congestion, or increased work of breathing. The patient has no other significant medical history. There are no known sick contacts. Patient is 38^th percentile for weight and 52^nd percentile for height. Temperature is 38.8°C (101.8°F), blood pressure is 75/32 mmHg, pulse is 140/min, respiratory rate is 20/min, and oxygen saturation is 99% on room air. The patient is sitting in his parent’s lap in no acute distress. Mucous membranes are dry. Cardiopulmonary examination reveals tachycardia, delayed capillary refill, and lungs are clear to auscultation bilaterally. Abdominal examination reveals suprapubic tenderness and left costovertebral angle tenderness. The results of initial laboratory studies are shown below. The patient is provided with intravenous fluids with improvement in blood pressure and capillary refill and empiric antibiotics are started based on the most likely diagnosis. Which of the following best describes this patient’s disease process?

Laboratory Value	Result	Reference Range
Serum Chemistry
Sodium	131 mEq/L	138-145 mEq/L
Potassium	3.9 mEq/L	4.1-5.8 mEq/L
Chloride	97 mEq/L	98-106 mEq/L
Creatinine	2.6 mg/dL	0.1-0.5 mg/dL
Albumin	3.2 g/dL	3.5-5.2 g/dL
Urine
Erythrocytes	0/hpf	Negative
Leukocytes	100-150/hpf	Negative
WBC Esterase	Large	Negative
Nitrite	Positive	Negative
Bacteria	Large	Negative
Complete Blood Count
Hemoglobin	12.5 g/dL	11.5-13.5 g/dL
Hematocrit	36.8%	34-40%
Leukocyte count	19,100/mm3	5,100-13,400/mm3
Platelet count	400,000/mm3	150,000-450,000/mm3