Pediatrics

During the physical examination, we were unable to elicit findings typical of pneumonia such as dullness on both the lower lung fields, crackles, and increased breath sounds. We attributed this to the medications that were already taking effect on the day prior to conducting the physical examination. Administration of antibiotics and expectorants relieves the pulmonary congestion by reducing the bacterial load and purging the mucus that clogs the bronchi. The resolution of the disease in the patient hence results in a reduction in symptoms.

Arriving at a particular diagnosis involves taking note of the chief complaint together with the history of the present illness. This enables us to note the course of the disease over time and monitor the progression at the same time it permits the determination of the etiology. Although the history of the present illness provides the clinician with a tentative working impression of community acquired pneumonia, cough and tachypnea are still very broad and nonspecific manifestations. Therefore, it pays to note all the other possible etiologies that could manifest with a similar chief complaint. The discussion will begin with outlining some of the possible extrapulmonary etiologies to the likely pulmonary diseases.

We will first consider some of the major extrapulmonary etiologies that could bring about respiratory symptoms in an infant. These would include namely gastrointestinal, metabolic and immune etiologies.

An endocrine problem that we could consider in this case is hypoglycemia. This occurs whenever the serum glucose falls below 40 mg/dL. It usually occurs in sick, stressed infants, in preterm neonates, in cases of respiratory distress or cardiac diseases, or in infants of diabetic mothers. Typically, the infant manifests with nonspecific symptoms such as lethargy, apnea, seizures, jitteriness, poor feeding, or the infant may be simply asymptomatic. There may be enhanced uptake and utilization of glucose in