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Case 3: Episodic Weakness in an 18-month-old Girl

1. Matthew Dietz, DO*
2. Michael Jones, MD*
3. Melissa Svoboda, MD*
4. Erika Finanger, MD*


 

1. *Department of Pediatrics, Doernbecher Children's Hospital, Oregon Health & Science University, Portland, OR.

An 18-month-old girl presents to the emergency department with upper respiratory tract symptoms and acute onset of weakness. Her mother reports that a few hours into a road trip the child became “floppy,” was “gurgling,” and had difficulty breathing. Her parents are concerned because she was admitted to the pediatric intensive care unit (PICU) at 12 months of age with a similar event, resulting in acute cardiorespiratory failure.

She was born at term via cesarean section for breech presentation and required resuscitation. She spent 14 days in the neonatal intensive care unit for hypotonia, respiratory distress, and feeding difficulty. She continued to have feeding difficulty but eventually “outgrew” it. She developed normally and walked at approximately age 14 months.

Upon physical examination, the afebrile girl has a respiratory rate of 26 breaths per minute, heart rate of 106 …