Thanks for the response...but to clarify AND as mentioned in the original
question....I called the Peds Hospitalist, who admitted the pt. to the
general peds floor...we have a wonderful PICU attending who is imbued with zeal,
that saw the chart and saw the original and the second order.
In a message dated 8/7/2009 8:45:38 P.M. Central Daylight Time, peterantevy
We have a standard protocol using Ampicillin at 100mg/kg as a standard
dose. Having said that, Ampicillin is used routinely to cover for
Listeria, an organism which rarely causes meningitis in infants >28
days. So in this case of a 5 week old, the ampicillin dose may be
irrelevant. However, to avoid this problem in the future........don't
send well appearing infants with a 64 WBC in the CSF to the PICU ;)
On Aug 7, 2009, at 11:21 AM, [log in to unmask] wrote:
> Ok...I am trying to summarize this as briefly as possible...
> I had a 5 week old, nl birth hx, no maternal herpes/lesions, feeding
> temp at home 101.6 Axillary, no fever in ER.
> Pt. looked well, NL exam except classic viral exanthem.
> I did a "complete sepsis w/u":
> WBC 18 nl diff, lytes nl, UA nl, serum glucose from lytes 75
> CSF 64 WBC's, 2 RBC's, CSF Glucose 38, CSF protein 78, CSF gram
> stain -
> CXR -
> I ordered 50mg/kg of ampicillin and 50 mg kg of cefotaxime and
> called for
> admission. The peds hospitalist, a great guy, asked if I would mind to
> increase my amp dose to 100mg/kg and to add on acyclovir.
> I complied, not the biggest deal in the world.
> To me, this was 64 WBC's, NL gram stain, with obvious viral exanthem,,
> clinically I was thinking this was most likely a viral meningitis.
> Turns out the CSF Enteroviral PCR was +.
> The PICU attending, kindly asked me why I did not give 100mg/kg of Amp
> right away, rather than 50mg/kg that I originally ordered. And this
> was asked
> in a very non confrontational manner.
> My answer was, as above, classic viral exanthem, 64 WBC's, nl CSF gram
> stain, and this appeared to be a viral meningitis. PICU attending's
> was, basically, that he felt that if there is ANY abnormality on the
> tap we
> should start with the higher amp dose in the ER.
> I am a believer of making errors in the side of caution (to a
> degree, of
> course), and I have been thinking about this for the past 2 hours
> To my Peds ER colleagues....do you give 100mg/kg of amp with any,
> and I
> mean ANY abnormality to the CSF, whatsoever.....
> Thanks for considering this....
> -Todd Z
> Dr. Todd Zimmerman
> Medical Director, Pediatric Emergency Medicine
> St. Alexius Medical Center/Alexian Brothers Medical Center
> Midwest Emergency Associates
> CMO, PIRRGA
> For more information, send mail to [log in to unmask] with
> the message: info PED-EM-L
> The URL for the PED-EM-L Web Page is:
For more information, send mail to [log in to unmask] with the message: info PED-EM-L
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