episode_0197

Episode 197. A Village for Children (1)

****

Second patient of the day.

The second patient was a young child with somewhat shabby appearance. Something felt familiar – ah. It was the child from the daycare I went to last time.

Those are the clothes they give out to children at the daycare center. You could call them uniforms, but they came with a woman who seemed to be their guardian.

“What hurts and why are you here?”

“Ah. That’s it.”

It’s unfortunate, but people in difficult situations get sick more often and more severely. I waited a while, and the woman began to speak.

“Oh, my name is Gloria, and the child’s name is Chase. He’s a child in a daycare center.”

“Yes.”

“My child has been having trouble urinating recently, and the color of his urine has been unusually dark for the past few days. It’s a bit strange.”

“You looked at it carefully.”

If you live in a group environment, it would be easy to miss small things. Management seems to be thorough.

It could be a child who is loved.

“I was so worried because I didn’t know the cause, so I brought him to the hospital. It’s not a serious illness, right?”

“Okay, so you’re saying that there’s nothing else, but your urine is darker?”

“The child seems to have no energy.”

I sighed inwardly. The scariest thing is to hear that a child has no energy. It is harder for children to communicate than adults.

Feeling lethargic can be just because you’re a little sleepy, or, in extreme cases, it can be because you can’t open your eyes due to a serious illness like meningitis. It’s the most troublesome symptom.

“The reason you came to the hospital was urine?”

“Yes.”

It doesn’t matter how dark it becomes.

“Let’s take care of the child first.”

Sister Gloria placed the child in front of me. I can only assume she was a nun, since she wasn’t wearing a habit.

Anyway, let’s see the child.

A boy who looked to be about 8 years old. He looked sleepy, but it wasn’t unusual for him to look sleepy, as he might have taken a carriage to get here, or waited in the hospital waiting room.

Considering that she was living in an orphanage, she seemed quite healthy. Her skin tone was normal, her eyes were normal, and her teeth were normal except for a few overbites.

No. Your skin tone is not normal. You may be a little dehydrated. That may be why you look sleepy…

“Istina. Go get me some water.”

“Yes.”

I turned my gaze back to the child.

“Are you sleepy now?”

“No, it’s okay.”

He was mature for his age. I felt a little sad. He must have had a hard time until he became mature for his age.

“Have you been sick recently?”

“No. I want to drink water often.”

There’s not enough information. I want to drink water, my urine is darker, I’ve been feeling tired lately, that’s about it.

“Have you had foamy urine recently?”

“Piss… … . Yeah!”

Added that there were bubbles in the urine.

“First of all… … . I think we need to see the patient’s urine to get a conclusion. Please continue drinking water at the hospital until you see the urine.”

Gloria nodded. Istina returned and placed a glass of water in front of the child.

“Then, please wait in the waiting room.”

People usually urinate within an hour of drinking water. It shouldn’t take long. If it takes too long, it could be a symptom in itself.

****

A few minutes later, a vial of urine returned from the waiting room. We were able to collect the patient’s urine. It was a slightly dark, almost orange-colored, cloudy urine.

Istina scratched her head.

“Did you figure something out?”

“You?”

“I don’t know.”

I’m starting to get a feel for what kind of illness it is.

“Istina. Do you know what urine is originally?”

“Well… …. Isn’t urine the waste product that is removed from the blood by filtering it in the kidneys?”

“What kind of waste?”

“I don’t know.”

It’s because of a yellow chemical called urobilin. I’ve been trying to figure out how to explain it so that people can understand it as best as possible.

It’s not the euro bill that’s important.

“Is urine originally yellow and transparent?”

“Yes.”

“This is orange and opaque.”

“That’s right.”

Even if you don’t know the composition of urine, this is something you should know if you have a concept of color.

“Then, Istina. What color should I mix with yellow to get orange?”

“It’s red.”

“Is there red liquid inside your body?”

“Red liquid? The blood inside the body is red- Ah. Are you saying that urine of this color should also be considered hematuria?”

I nodded.

It took some time, but it worked.

“There’s something wrong with your kidneys, and blood is coming out in your urine. I’ll have to think about it for a bit to figure out exactly what it is.”

“Yes. But is there a cure?”

I nodded. The most important thing right now is to drink a lot of water. You may also need to take intravenous fluids.

I’ve been feeling mildly dehydrated since I got here, and now the blood is leaking out of my body through my urine.

By the way, there were more than one or two possible causes. There are hundreds of diseases that can cause hematuria in children.

Confirming that you have hematuria is not the end.

“Then. What do you think could be the reason for blood in urine?”

“Trauma seems to be the most common.”

“What is the probability of infection?”

“If it was caused by some infectious disease, wouldn’t several children have come to see me?”

That’s a sharp observation.

Considering the patient’s situation, if the illness was caused by an environmental or infectious agent, the patient would not have come to the hospital alone.

The possibility of toxins or bacteria is reduced.

****

Hematuria. Blood in the urine.

First, you have to think about where the blood comes from. Does it come from the kidneys? The ureters? The bladder? The prostate? The urethra?

“Considering that the child is tired and dehydrated, it is most likely a kidney problem.”

“That’s right.”

If the bleeding was only coming from somewhere other than the kidney, there would be no reason for him to complain of such discomfort all over his body. It is true that the kidney was injured.

“Then. Why did the kidney have a problem? There was no sign of the patient being injured or hit?”

“Yes.”

The most common cause of hematuria is strenuous exercise, but it doesn’t seem likely that this child has been exercising strenuously recently. I should ask.

So what’s left then?

It was most likely a disease such as nephritis or glomerulonephritis. It could be an inflammation caused by bacteria, or there could be other causes.

Ah. It could be a hemolytic disease. It could be a hemolytic disease caused by bacterial toxins, that is, a disease in which red blood cells are destroyed in large quantities.

That’s a pretty serious disease.

“But. The fact that there is blood in the urine is a pretty serious situation, right?”

I nodded.

Even healthy people can have small amounts of blood in their urine due to reasons such as strenuous exercise.

If there is blood in your urine that is visible to the naked eye, then the problem is serious. There is a problem in your body that absolutely needs to be addressed.

“This patient. No signs of infection, right?”

“There was no fever at all.”

I wrote down what came to mind in my medical records. What should I check again?

How well you urinate, are there any signs of inflammation, have you recently eaten strange foods, had an upset stomach, or been injured?

“Bring the patient’s guardian. I’ll ask a few last questions and then make a diagnosis.”

“Yes!”

Istina nodded and left the examination room to find the patient’s guardian.

****

The conclusion is almost there, but there is still an interview with the patient’s guardian. After all, there is the special circumstance of living in a group.

There’s a little more to check.

This time, the patient’s guardian came into the examination room. As expected, with a serious expression.

“Ms. Gloria, do you work at a daycare center?”

“Yes.”

“Chase, you said… … . He’s healthier than I thought. He grew up in an orphanage, but I was surprised that he didn’t seem to have had a hard time growing up.”

“Thank you.”

Ms. Gloria bowed her head.

Let’s get back to the main topic.

“Are there any other sick children besides Chase? Children with similar symptoms.”

“There was none.”

“Have you eaten anything unusual recently?”

“Well, I guess my usual diet has changed a bit over the end of the year. Is it a special food?”

“Your stomach hurts after eating.”

“No, there was nothing like that.”

I wrote the answer in the medical record. Hemolytic syndrome caused by toxins produced by bacteria can accompany food poisoning.

The principle is similar.

The most representative example is hemolytic uremic syndrome caused by Escherichia coli that produces Shiga toxin.

It’s a bit difficult to explain. It’s a theory that bacterial toxins in food can become poisons that attack red blood cells. It’s probably better known to the public as hamburger disease.

If hamburger disease occurs in a child who lives in a group, it is highly unlikely that it occurred alone.

So, this is something I absolutely had to check.

I’m glad that’s not the case.

I turned over my military records.

Let’s summarize the results. Hematuria suddenly occurred in an 8-year-old boy. There was no evidence of trauma, and there was no recent history of bacterial infection or food poisoning. He complained of dehydration, fatigue, and thirst.

The conclusion is out.

The most likely diagnosis is… … .