An 18-month-old boy was presented to our hospital. The patient presented with weight loss of 3 months’ duration and generalized body swelling for the previous 3 weeks. He also had had watery diarrhoea and fever for 1 day prior to admission. At admission, the child was afebrile with a pulse rate of 100 beats/min and a respiratory rate of 28 breaths/min. He had severe palmar pallor, puffy face, and pedal oedema with peeling of skin in the lower limbs. The child’s weight was 8.2kg, length was 78cm, and mid-upper-arm circumference was 11cm. His weight for length was between a –2 standard deviation (SD) and –3SD Z-score according to World Health Organization growth standard charts.
Examination
He had hepatomegaly of 3cm below the right lower costal margin. The diagnoses of acute watery diarrhoea and severe anaemia (not in anaemic heart failure) were made. His serum albumin was 13g/L; serum creatinine was 30.5μmol/L, serum sodium 129mmol/L, and serum potassium 3.6mmol/L. The complete blood count revealed Hb of 8.5g/dl, mean corpuscular volume 52.5fl, mean corpuscular Hb 16.2pg, and white blood cell count 9.07 × 103/μL. Urinalysis was normal, blood slide had no malaria parasite, and serology screening for human immunodeficiency virus, hepatitis B virus, and hepatitis C virus was normal.
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