Sunday, July 30, 2006

the magical fluid bolus

a little girl came in to the ED today with a fever to 39.5. i had spoken with her mother several hours earlier about the fever, as well as some bug bites that looked infected and asked them to come in to make sure the bites weren't cellulitic. at that point, her mom told me over the phone that she wasn't too worried, because she was still playing.

by the time she got to the ED, she was no longer playing.

she was, in fact, lethargic.

the dreaded L word that parents throw around willy-nilly without proper respect for the weight it carries. it does not mean they're sitting on the couch all day playing video games or just wanting to watch movies. it means that they are sleepy and very difficult to wake up.

this girl slept through my exam, including the belly exam. even still, this mom did not describe her daughter as lethargic, but, rather, as "a little more sleepy than usual".

1 IV, 300cc of NS, 240mg of tylenol...and presto!

all better.

up, talking, smiling, asking for apple juice and stickers that were pink.

i gave her all the pink stickers we had, including the one of the bear with a pink bow and the caption, "i'm all better!"


Wrkinprogress said...

Tie-dye band-aids would do it for me. :)

Flea said...

Lethargy is a bit more than excessive sleepiness! I also wonder if dehydration alone can give "textbook" lethargy if a single bolus reverses the process!

I define lethargy as a child who is awake as long as you shake them or otherwise futz with them, and then falls asleep as soon as you stop touching them.

These kids are emergently ill. You must consider a central nervous system infection in a truly lethargic child.

I trust that if this kid had been truly lethargic, and hadn't perked up with the bolus she would have gotten a needle in the back, cellulitis or no cellulitis!



Sid Schwab said...

Seeing an obit in the local paper the other day about a man in his forties who died of a ruptured appendix, I was reminded of a young girl I saw who was beyond lethargy. She'd been feverish and vomitting at home for several day, under the parental assumption of "flu." When she came in she was not only unarousable, but braycardic and hypothermic. She, too, perked up with fluids, but only a little. Her belly was as full of pus as I've ever seen, from a long-ruptured appy. Happily, being 6, she made a full and remarkably complication-free recovery. Lethargy. Bad word indeed.

Flea said...


You didn't like my comment?


Fat Doctor said...

Drives me nuts when parents, or worse yet DOCTORS, use the word lethargic inappropriately. Especially when written in a medical record, this term can have serious implications. Glad your patient turned out OK.

girl MD said...

to those who have been waiting for their comments to appear...i apologize for the delay. i just started in the picu and have been neglecting the blog. all comments welcome.

Karen Little said...

Isn't it amazing what a bit of fluid can do? It's like that special potion on computer games - one small vale of the stuff, and watch the life flow back. Magical!

sister smile said...

I think the medical implication of the word lethargic is lost on me. I tend to associate it with being run-down, not getting enough sleep, and generally not feeling quite right.

Kungfukitten said...

I love happy endings. I remember after a really rough visit to the ER, the pharmacist gave me some kitten stickers because she overheard me whisper - "Are those kitties? I want some kitty stickers." Yeah, I'm in my 30s. ;) I still have them in my cubicle at work and they always make me smile.