Limping child

It was an unusual occasion that you witnessed the admission of a case from OPD which was then transferred to ICU within the same day.

A 22-month-old boy was presented to the Renal Clinic for follow-up of his congenital bilateral PUJO, with OT done. During the assessment, his mother revealed to the doctor that the child failed to walk suddenly this morning, and that the child was absolutely normal the day before. On examination, you found that there was decreased flexion of the left hip, with circumduction of left lower limb while on walking. No obvious tiptoeing gait was observed. He was able to walk for about 2-3m, and then fell to the ground. Gower sign was not assessed during that clinic visit. Otherwise his upper limbs and Rt lower limb appeared normal. No obvious muscle loss was found.

The child had a preceding history of gastroenteritis about 1 week ago. No medical attention was sought, and the bowel opening was improving. Otherwise there was no coryzal symptoms.

What are your differential diagnoses in mind? At that time I got only one dx: transient viral synovitis.

After the admission, various blood tests including inflammatory markers, muscles enzymes, and electrolytes were performed. Result came back to show that the serum potassium was just 1.6! The child was then admitted to the PICU, with A-line inserted and parenteral replacement of potassium was given. ECG was also done and there was no obvious features of arrhythmia.

Other electrolytes: Ca 2.35, PO4 0.6, Mg 0.69 (N: 0.7-1.05); Urine test does not suggest renal loss of potassium.

Child was otherwise still very cheerful, and climbing around in the bed.

Lesson to learn: GE can be dangerous in children. ^^”

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