Kawasaki disease: Difference between revisions

Revision as of 20:50, 22 June 2011

Diagnosis

CDC Definition

Fever >5d and 4 of the following:

Rash
Cervical LAD (>1.5cm diam, usually unilat)
Bilateral nonexudative conjunctivitis
Oral mucosal changes
Extremity edema/erythema/desquamation

Associated Sx

Cardiac
1. Coronary aneurysm
  1. Most develop during 3-4th week of illness
  2. May lead to MI (leading cause of death)
2. Myo/pericarditis
3. Pericardial effusion
4. LV dysnfunction
5. Valvular dysfunction
6. Dysrhythmias
Labs
1. Elevated ESR/WBC/LFTs/Plts
Aseptic meningitis
Urethritis, Anemia
RUQ pain, large GB (hydrops)

Work-Up

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

Treatment

Immunoglobulin
1. IVIG 2gm/kg over 12hr
ASA 20mg/kg/dose q6h

Disposition

Cardiology f/u
Cont ASA at high dose
1. Switch to ASA 3-5mg/kg/day once afebrile x48h

Source

Tintinalli

Authors:

@@ Line 1: / Line 1: @@
-==Diagnosis==
+== Diagnosis ==
-A. Fever >38.5 (101.3) x >4dys
+CDC Definition
+*Fever >5d and 4 of the following:
-AND
-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)
-Also associated with platlets >1k
-==CDC Dx criteria==
-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
+#Cervical LAD (>1.5cm diam, usually unilat)
+#Bilateral nonexudative conjunctivitis
-===CRASH===
+#Oral mucosal changes
-C- conjunctivitis
+#Extremity edema/erythema/desquamation
-R- rash
-A- aneurysm
+=== Associated Sx ===
+#Cardiac
-S- strawberry tongue
+##Coronary aneurysm
+###Most develop during 3-4th week of illness
-H- hands feet changes
+###May lead to MI (leading cause of death)
+##Myo/pericarditis
+##Pericardial effusion
-===Associated Sx===
+##LV dysnfunction
-#High ESR/WBC/LFTs/Plts
+##Valvular dysfunction
+##Dysrhythmias
+#Labs
+##Elevated ESR/WBC/LFTs/Plts
 #Aseptic meningitis
 #Urethritis, Anemia
-#RUQ pain, big GB (hydrops)
+#RUQ pain, large GB (hydrops)
-#Irritability, N/V/D
+== Work-Up ==
-==Work-Up==
 #CBC/Diff/SPA/ALT/TBili
 #Blood Cx and UA
@@ Line 54: / Line 32: @@
 #Red Top "Kawasaki Serum to CBR"
-==Treatment==
+== Treatment ==
-#Vitals:
+#Immunoglobulin
-##q6h pre ASA doses
+##IVIG 2gm/kg over 12hr
-##During IVIG/ Steroid Rx:
+#ASA 20mg/kg/dose q6h
-###cardiac monitor during infsn
-###q15min x1h
-###q30min x1h
-###q1h for remainder
-#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
-==Disposition==
+== Disposition ==
-#F/U w/ cardio
+#Cardiology f/u
-#Cont ASA at high dose, switch to ASA 3-5mg/kg/day once afebrile for 48h
+#Cont ASA at high dose
+##Switch to ASA 3-5mg/kg/day once afebrile x48h
-==Source==
+== Source ==
-Adapted from Donaldson, Pani
+Tintinalli
-Sundel et al, J Peds 142 June 2003
 [[Category:Peds]]
-[[Category:Cards]]