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1 病例介绍 患儿,女,3岁。因持续高热4d,恶心呕吐1d入院。入院前4d无明显诱因持续高热,体温39℃～41℃伴寒战、一过性肉眼血尿,无明显尿路刺激症状,尿量略少。当地医院给予青霉素抗炎和口服对乙酰氨基酚(扑热息痛)0.25g/次,q4h,连用3d症状无明显好转。入院前1d出现恶心,频繁呕吐转入我院。查体:T39.2℃,P124次/min,R30次/min,BP12kPa/9kPa。发育营养正常,精神差,全身皮肤、巩膜轻度黄染,表浅淋巴结无肿大,心肺未见异常。腹软,肝肋下3cm,质软触痛,移动性浊音阴性。双下肢皮肤水肿,无神经系统阳性体征。化验:血常规:HB105 g/L,WBC19.6×10~9/L,N 0.86,L 0.14,BPC156×10~9/L。尿常规:蛋白++,RBC10～12/HP,WBC满视野。中段尿培养:大肠埃希杆菌生长,菌落计数30万/ml。血生化:K4.8 mmol/L,Na138
1 case description Children, female, 3 years old. Due to sustained high fever 4d, nausea and vomiting 1d admission. 4d before admission there was no obvious incentive to sustained high fever, body temperature 39 ℃ ~ 41 ℃ with chills, transient gross hematuria, no obvious urinary tract irritation, slightly less urine output. Local hospital for penicillin anti-inflammatory and oral acetaminophen (paracetamol) 0.25g / times, q4h, even with 3d symptoms no significant improvement. 1d before admission, nausea, frequent vomiting transferred to our hospital. Physical examination: T39.2 ℃, P124 times / min, R30 times / min, BP12kPa / 9kPa. Development of normal nutrition, mental retardation, systemic skin, scleral mild yellow dye, superficial lymph nodes without swelling, no abnormal heart and lung. Abdomen soft, liver ribs 3cm, soft tenderness, mobility dullness negative. Lower extremity skin edema, no positive signs of nervous system. Laboratory tests: blood: HB105 g / L, WBC19.6 × 10 ~ 9 / L, N 0.86, L 0.14, BPC156 × 10 ~ 9 / L. Urine routine: protein ++, RBC10 ~ 12 / HP, WBC full field of vision. Urinary culture in the middle: Escherichia coli growth, colony count 300000 / ml. Blood biochemistry: K4.8 mmol / L, Na138