Age: 0.17
Sex: M
Vaccine: DTAPIPVHIB, PNC20
Symptoms: Urine ketone body present, Urticaria, White blood cells urine negative
Clinical narrative: The patient is a 2-month-old child who was recently admitted on 4/24/25 for dehydration. He was admitted from the ER due to poor oral intake and fussiness following his 2-month vaccinations. He had a temperature of 99-100°F in the evening after vaccination but no fever since then. During hospitalization, he was placed on IV fluids and improved. Blood sugars were stable prior to discharge. Blood cultures showed no growth after 3 days. CBC had a mild thrombocytosis of 542 with 1 metamyelocyte. Urine drug screen was negative. Urine culture showed no growth. He had 1+ ketones, 3 white cells, 1 red cell, and 150 glucose in his urine with initial presentation of a glucose of 222. Initial presentation of glucose in the ER was a blood glucose of 45, and he was given glucose gel and D10, which was probably responsible for his elevated blood glucose and his glucose in his urine. He is here for follow-up. He is accompanied by his mother.  The patient's mother reports that he experienced an adverse reaction to his vaccines, manifesting as a refusal to eat, hives, abnormal spasms, and the presence of blood in his urine. These symptoms appeared within an hour of the vaccination. He also exhibited lethargy, holding the nipple in his mouth without sucking or eating. Once the IV treatment began, he resumed eating but with weakened mouth muscles, resulting in milk spillage. The mother had to downgrade the nipples to accommodate this change. He also developed a pinkish discoloration in his diaper, which was attributed to dehydration or urate crystals. His cry has changed, sounding more congested and different. He had some vesicles that were opening up on his left foot, but there is no evidence of cellulitis, redness, or swelling. He was unresponsive during his hospital stay but has since regained his smile. He became lethargic within an hour of the vaccines, crying constantly and inconsolable for hours. He stopped eating completely, developed hives, and exhibited red flushes under his feet and legs. He also displayed unusual movements, falling forward and backward rapidly, which continued even in his sleep, disrupting his sleep pattern. These symptoms were most severe in the first 24 hours post-vaccination. He became easily startled by loud noises. His condition has improved, with the exception of a change in his cry and persistent muscle spasms. His coloration has returned to normal. He did not have a bowel movement for a few days after the vaccination but did not have any blood in his stool. The mother is considering giving him probiotic drops and is seeking advice on this.  Diet, Intake & Output: The patient is bottle-fed. He had poor oral intake following his vaccinations but resumed eating after IV treatment. He did not have a bowel movement for a few days after the vaccination.  Sleep: The patient's sleep pattern was disrupted by unusual movements following his vaccinations. He would wake up due to muscle spasms and cry before falling back asleep.  During admission, did have IV infiltration: noted to have left foot IV infitration on the evening of 4/24. Hyaluronidase given with good resolution. Still with some skin breakdown.