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A mother brings her 12 month old child, a new patient for your clinic, for a well child visit. The infant appears to be small for her age. Her weight is below the 5th percentile on standardized growth curves (50th percentile for an 8 month old), her length is at the 25th percentile, and her head circumference is at the 50th percentile. Her vital signs and her examination otherwise are normal. What is the most likely diagnosis?
Failure to thrive, probably non-organic cause
What is the definition of failure to thrive?
Growth is below 3rd or 5th percentile or crosses more than two major growth percentiles
need more of the drug to get the same effect
symptoms associated with not taking a drug/medication
continuing to use a substance even though you are causing harm
How many kilocalories of nutrition should healthy infants receive in the first year of life per day?
How many kcal of nutrition shoud a child receive after the first year?
How much more nutrition should a failure to thrive child consume?
50 to 100% more than a normal infant (normal infant = 120 kcal/kg/day)
A healthy 16 year old adolescent male arrives at your office with his parents, who are concerned about his several months' history of erratic behavior. At times he has a great deal more energy, decreased appetite, and less sleep requirement than usual; at other times he sleeps incessantly and is lethargic. He is doing poorly in school. Last evening he appeared flushed and agitated, he had dilated pupils, and he complained "people were out to get him." The family notes that he has been skipping school occasionally, and they reluctantly report that he was arrested for burglary 2 weeks previously. You know he is in good health and he previously has been an excellent student. Today he appears normal.
Drug abuse (probably cocaine or possibly amphetamines)
What are signs of marijuana use?
- impaired short term memory
- poor concentration
What are signs of cocaine use?
- dilated pupils
- increased motor activity
What are signs of methamphetamine use?
- increased sensual awareness
- blurred vision
- panic attacks
What are signs of opiate use?
- pinpoint pupils
- possible respiratory depression
- decreased pain sensation
What are signs of PCP use?
- emotional lability
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