Patient History: A 2-year-old boy, with a past medical history significant for sickle cell anemia and hemophilia B, presented to the pediatric intensive care unit (PICU) with an altered mental status. Symptoms of lethargy and decreased activity began approximately 1 day prior to admission. The mother reported difficulty in arousing the patient on the day of admission.
The patient also began to have symptoms of nausea and vomiting on the day of admission. Review of symptoms was negative for fever, chills, trauma, injury, and recent ingestions or medications. Family history: Brother and maternal grandfather with hemophilia Physical Examination: General appearance: Patient intubated and sedated Vital signs: T 99.8°F, HR 191, respiratory rate 18, BP 90/61 mm Hg HEENT: Head normocephalic and atraumatic; pupils equal and reactive to light at 3 mm in size bilaterally, no icterus; endotracheal…
