Little girl with nephrotic syndrome

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Background

  • pleasant, talkative, 9 year old girl (Kyla)
  • Nephrotic syndrome
  • Had some swelling in face, which would go away after an hour or so
  • This was usually as soon as she woke up, and by the time she was headed to school, it would be going down.
  • Ankles were also swollen
  • Went in to walk-in clinic on a thursday
  • On a tuesday, she was swollen enough to go to emergency
  • Released from hospital
  • On Friday, went back to ER
    • she was wildly swollen all over
    • 20 lbs of fluid, very swollen stomach
  • Diagnosed a month after the swellings began
  • Given an ultrasound
  • Put on prednisone (8 pills every other day?)
  • Now on a salt-reduced diet
  • It has been difficult to cut out salt from the diet
    • 636mg of salt in a slice of bologna
  • Favourite food is goulash; second favourite: ham. Chocolate is not a food
  • Challenge dealing with the whole family (3 sisters)
  • When she got back home, she didn't drink as much because of the IV while on hospital, and so she got dehydrated
  • No family history
  • Air-popped popcorn instead of microwave stuff
  • No side-effects of prednisone for her
  • enjoyed food at hospital
  • enjoyed nurses; just had to push a button
  • Wants to be a nurse, not doctor, since nurses do all the work
  • Peritonitis was suspected, and white count was high in the fluid
  • She was on ampicillin and cephalosporin, but had an anaphylactic reaction, and so was switched to vancomycin
  • does her own testing with pee in a cup and an albumin stick
  • Lived in London for 4 years, but still has no family doctor
  • Have tried the net and have actively searched for a family doctor
  • Feel that walk-in clinics are set-up only to make a fast buck
  • Started Prednisone on 65mg every other day
  • Tapered to 40mg every other day
  • Have been in Alberta, where it was easy to find doctors; same in montreal

Possible Objectives

  • What is the prognosis?
  • What's the deal with the salt diet?
  • What's the etiology?
  • What do members of the public have to do to get a doctor? specifically in the city of London
  • Why is there a shortage of family doctors?
    • What is the ratio of walk-in doctors to family doctors?
  • Treatment/outcome differences in kids who are involved in their own care?
  • Possible long-term reprecussions of low-salt diet
  • What's the deal with walk-in clinics?

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