Kawasaki disease: Difference between revisions

(Created page with "==Diagnosis== A. Fever >38.5 (101.3) x >4dys AND B. 4 of the following: 1. Extremity edema/erythema/desquamation 2. Polymophous exanthem 3. Bilat conjunctiv...")
 
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==Diagnosis==
==Diagnosis==
A. Fever >38.5 (101.3) x >4dys
A. Fever >38.5 (101.3) x >4dys


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B. 4 of the following:
B. 4 of the following:
# Extremity edema/erythema/desquamation
# Polymophous exanthem
# Bilat conjunctival injection
# Lip/oral chages (red lips, straberry tongue)
# Cervical LAD (>1.5cm diam, usually unilat)


    1. Extremity edema/erythema/desquamation
Also associated with platlets >1k
 
    2. Polymophous exanthem
 
    3. Bilat conjunctival injection
 
    4. Lip/oral chages (red lips, straberry tongue)
 
    5. Cervical LAD (>1.5cm diam, usually unilat)


*Also associated with platlets >1k
CDC Dx criteria:


==CDC Dx criteria==
Fever >5 days and 4/5 of:
Fever >5 days and 4/5 of:
#Bilateral conjunctival injection
##limbic sparing
#Oral mucosa changes
##erythema of lips or OR
##strawberry tongue
##dry cracked lips
#Peripheral extremity changes
##edema
##erythema
##periungual desquamation
#Rash
#Cervical LAD >1.5cm


Bilateral conjunctival injection
===CRASH===
 
  limbic sparing
 
Oral mucosa changes
 
  erythema of lips or OR
 
  strawberry tongue
 
  dry cracked lips
 
Peripheral extremity changes
 
  edema
 
  erythema
 
  periungual desquamation
 
Rash
 
Cervical LAD >1.5cm
 
 
C- conjunctivitis
C- conjunctivitis


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===Associated Sx===
Associated Sx:
#High ESR/WBC/LFTs/Plts
 
#Aseptic meningitis
  High ESR/WBC/LFTs/Plts
#Urethritis, Anemia
 
#RUQ pain, big GB (hydrops)
  Aseptic meningitis
#Irritability, N/V/D
 
  Urethritis, Anemia
 
  RUQ pain, big GB (hydrops)
 
  Irritability, N/V/D
 


==Work-Up==
==Work-Up==
 
#CBC/Diff/SPA/ALT/TBili
 
#Blood Cx and UA
Labs:
#ECG
 
#Echo (Coronaries, LV, Valves)
  CBC/Diff/SPA/ALT/TBili
#Red Top "Kawasaki Serum to CBR"
 
  Blood Cx and UA
 
  ECG
 
  Echo (Coronaries, LV, Valves)
 
  Red Top "Kawasaki Serum to CBR"
 


==Treatment==
==Treatment==
 
#Vitals:
 
##q6h pre ASA doses
Orders:
##During IVIG/ Steroid Rx:
 
###cardiac monitor during infsn
  Vitals:
###q15min x1h
 
###q30min x1h
    q6h pre ASA doses
###q1h for remainder
 
#Consults:
    During IVIG/ Steroid Rx:
##Full cardio
 
#Meds:
      q15min x1h
##ASA 20mg/kg q6h until afebrile
 
##Benadryl 1mg/kg IV pre IVIG
      q30min x1h
##IVIG 2G/kg IV over 8-12h
 
##IV methylprednisolone 30mg/kg [max 1.5gm] over 3 hrs before IVIG
      q1h for remainder
###pulse (shorter duration of fever, shorter hospital stay, lower ESR at 6 weeks.  Sundel et al, J Peds 142 June 2003)
 
      cardiac monitor during infsn
 
 
Consults:
 
  Full cardio
 
 
Meds:
 
  ASA 20mg/kg q6h until afebrile
 
  Benadryl 1mg/kg IV pre IVIG
 
  IVIG 2G/kg IV over 8-12h
 
  IV methylprednisolone 30mg/kg [max 1.5gm] over 3 hrs before IVIG
 
    pulse (shorter duration of fever, shorter hospital stay, lower ESR at 6 weeks.  Sundel et al, J Peds 142 June 2003)
 


==Disposition==
==Disposition==
 
#F/U w/ cardio
 
#Cont ASA at high dose, switch to ASA 3-5mg/kg/day once afebrile for 48h
  F/U w/ cardio
 
  Cont ASA at high dose, switch to ASA 3-5mg/kg/day once afebrile for 48h
 


==Source==
==Source==
Adapted from Donaldson, Pani
Adapted from Donaldson, Pani


[[Category:Peds]]
[[Category:Peds]]
[[Category:Cards]]

Revision as of 21:16, 7 June 2011

Diagnosis

A. Fever >38.5 (101.3) x >4dys

AND

B. 4 of the following:

  1. Extremity edema/erythema/desquamation
  2. Polymophous exanthem
  3. Bilat conjunctival injection
  4. Lip/oral chages (red lips, straberry tongue)
  5. Cervical LAD (>1.5cm diam, usually unilat)

Also associated with platlets >1k


CDC Dx criteria

Fever >5 days and 4/5 of:

  1. Bilateral conjunctival injection
    1. limbic sparing
  2. Oral mucosa changes
    1. erythema of lips or OR
    2. strawberry tongue
    3. dry cracked lips
  3. Peripheral extremity changes
    1. edema
    2. erythema
    3. periungual desquamation
  4. Rash
  5. Cervical LAD >1.5cm

CRASH

C- conjunctivitis

R- rash

A- aneurysm

S- strawberry tongue

H- hands feet changes


Associated Sx

  1. High ESR/WBC/LFTs/Plts
  2. Aseptic meningitis
  3. Urethritis, Anemia
  4. RUQ pain, big GB (hydrops)
  5. Irritability, N/V/D

Work-Up

  1. CBC/Diff/SPA/ALT/TBili
  2. Blood Cx and UA
  3. ECG
  4. Echo (Coronaries, LV, Valves)
  5. Red Top "Kawasaki Serum to CBR"

Treatment

  1. Vitals:
    1. q6h pre ASA doses
    2. During IVIG/ Steroid Rx:
      1. cardiac monitor during infsn
      2. q15min x1h
      3. q30min x1h
      4. q1h for remainder
  2. Consults:
    1. Full cardio
  3. Meds:
    1. ASA 20mg/kg q6h until afebrile
    2. Benadryl 1mg/kg IV pre IVIG
    3. IVIG 2G/kg IV over 8-12h
    4. IV methylprednisolone 30mg/kg [max 1.5gm] over 3 hrs before IVIG
      1. pulse (shorter duration of fever, shorter hospital stay, lower ESR at 6 weeks. Sundel et al, J Peds 142 June 2003)

Disposition

  1. F/U w/ cardio
  2. Cont ASA at high dose, switch to ASA 3-5mg/kg/day once afebrile for 48h

Source

Adapted from Donaldson, Pani

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