Muhammad Ali Ahmed, 10years old, from

Chamchamal, admitted at 4:30pm 29/5/2006.

He was complained of generalized abdominal
pain after car accident one hour before admission, It
was not associated with vomiting, no haematurea, no
history of lose of consciousness.
On examination; He was conscious, alert, looks pale,
dyspnoic, P.R130b/min., B.P90/50mm.Hg,
R.R32cycles/min.
Chest Bilaterally symmetrical, no tenderness, normal
breath sound.
Abdomen Bilaterally symmetrical, soft, tenderness on
all abdomen.
We put two i.v lines, & we gave him fluid &blood
after cross match. And we gave him oxygen by mask.
After resuscitation, we were reexamined him he was:
Conscious, G.C.S E6 M4 V5.
Pupil bilaterally symmetrical & equally reacting to
light.
Chest bilaterally symmetrical & equally move with
respiration, no tenderness, no added sound, normal
breath sound.
Abdomen bilaterally symmetrical & equally move
with respiration there was large abrasion on the right
loin, it was soft, but there was tenderness on all
abdomen mainly on the lower abdomen, bowel sound
positive, abdominal paracentesis was negative, P.R no
significant finding.
No restriction of limb movement apart from flexion
of right hip joint which was painful.
We send the case to the radiological department &
the result was:
normal C.X.R.
normal erect abdominal X.ray.
open book # pelvis.
normal X.ray of right femur.
I.V.U normal.
U/S of abdomen normal.
Hemtological investigation
Hb% 14tg/dl.(after given 4units of blood)
B.urea 20-30mg/dl.(daily we send it)
S.creatinine 0.7-0.8mg/dl.(daily we send it)
S.electrolyte normal.
We were treated him conservatively by given
parentral fluid intake ne & antibiotic(Ampiclox vial
500mg t.i.d), Tetracycline cap. 250mg q.i.d or
Medomycin cap. 100mg once daily, we asked his
family to bring Chlorpropamide tab from outside but
unfortunately not available.
We were observed his fluid intake & urine output
daily & we were found that U.O.P gradually
increased in amount inspiteof normal daily
requirement of parentral fluid intake,so we would
compensate his U.O.P, (ml. by ml.) by parentral fluid
intake & after three weeks his U.O.P gradually
returned to it’s normal value by the end of fourth
week.

This table show daily fluid intake & U.O.P

Day Fluid intake(cc.)i.v U.O.P(cc.)
1 3500 3600
2 1500 2400
3 1000 2500
4 1000 2000
5 3000 2400
6 3000 2600
7 2500 3000
8 2500 2400
9 2500 3800
10 2500 3200
11 no 2200
12 2500 2880
13 2500 3800
14 2500 5000
15 2500 4800
16 5000 6200
17 6000 8400
18 8500 11800
19 11000 14000
20 11000 17000
21 17000 12700
22 12000 11600
23 11000 10300
24 10000 8000
 25 8000 5200
26 6000 4000
27 5000 4500
28 4250 3500
29 1500 3000
30 no 1900
31 1000 2000

This diagram show daily fluid intake & urine

output
20000
Day
15000
Fluid
10000
intake(cc.)i.v
U.O.P(cc.)
5000

0
1 4 7 10 13 16 19 22 25 28 31