What happens during KD?
There are three phases: Phase I lasts from the onset of fever to day 10. Phase II lasts from day 10 to six weeks. And Phase III lasts from six weeks to six months.
Phase I - what may occur:
Your doctor usually diagnoses KD with five days of high uncontrolled fever and four of the *five criteria hi-lighted above. However, blood work test showing abnormalities and three days fever and three symptoms can diagnose as KD as well as a detection of coronary artery aneurysms. KD can be difficult to diagnose because many other serious illnesses can cause similar symptoms.
- Fever can reach 104 degrees and is non-responsive to Tylenol (acetaminophen), Advil (ibuprofen) or Motrin (ibuprofen).
- *A rash may show on the trunk or groin area.
- *The lymph nodes in the neck or groin may swell (mostly just one lymph swells). Min 15mm
- *Red eyes or conjunctivitis may be present
- *Bright red chapped lips that may crack and bleed
- *Swelling of the hands or feet
- The child may be vomiting and have diarrhea.
- Many children experience abdominal pain.
- Red mucous membranes in the mouth
- Rapid heart beat
- "Strawberry" tongue, white coating on the tongue or red bumps on the back of the tongue
- Red palms of the hands and the soles of the feet
- Pain in the large joints (knees, hips, neck)
- Severe migraine headache
If a KD diagnosis is received from day five to day 10, IVIG (Gamma-Globulin) is administered slowly through an IV in a hospital setting in addition to high dose aspirin. After day 10, the symptoms begin to diminish and the ability to properly diagnose also diminishes.
What is IVIG?
IVIG is 1000 bags of donor blood with the IgG immunoglobulins extracted or spun out to create one dose. The effects can last from 2 weeks to 3 months. It is not uncommon for a child to receive more than one IVIG treatment.
What tests are important?
Any fever over 100.3 Fahrenheit after IVIG is administered is problematic that the child is not successfully overcoming the infectious agent. Try Tylenol (acetaminophen), Advil (ibuprofen) or Motrin (ibuprofen) and if the fever returns again, you may be experiencing a relapse and another dose of IVIG or steroids may be needed. You should contact your doctor immediately.
- Complete blood count (CBC) may reveal anemic condition and thrombocytosis (high platelet count).Platelets aid the blood clotting process and when the count is very high, the risk of clotting is very high. The aspirin therapy is intended to keep the blood thin until platelets return to normal.
- Sedimentation rate (SED) - shows level of inflammation
- C-Reactive protein (CRP) - shows level of infection
- Liver function tests may show hepatic inflammation and low serum albumin
- Echo-Cardiogram - may show evidence of ventricular dysfunction or coronary artery changes and aneurysms later in recovery.
- Ultrasound may show enlarged gall bladder or other digestive tract inflammation problems
- Urinalysis may show white blood cells and protein in the urine. This shows the body is fighting something off.
You should have a follow-up echo with a pediatric cardiologist at two weeks and additional blood drawn to check CRP and platelet count as well as a check for anemic condition.
You should have orders from the cardiologist to continue low-dose (81mg) aspirin a day.
The finger skin and/or toe skin may peel off. Do not pull or cut the skin off. Try to keep them covered with socks for 2-3 days. The skin around the genital area may peel as well.
Transverse grooves on nails may appear and some children have total nail regrowth.
Your child should resume normal activities as soon as they start feeling better.
What do I need to know about aspirin therapy?
- Contact sports should be avoided while on aspirin therapy.
- Direct contact or exposure with a person with flu or chickenpox should be avoided. Aspirin therapy can be safely stopped for up to two weeks if necessary due to exposure. Reye's Syndrome is possible to contract due to flu virus and aspirin therapy together.
- Long term aspirin therapy will require a health directive on file at school.
Last echo is done at 6 weeks and if the test is normal, your child should be cleared by the doctor to stop taking daily aspirin.
Your child's behavior should have already returned to normal (outbursts are normal for a KD child) or will begin returning to normal soon.
Your child's energy level will return.
Your child's appetite will return and any weight loss from previous phases may be regained.
You can expect to see your cardiologist again at 6 months and one year. If any problems are noted, it will be every year thereafter or every 2-3 years thereafter for non-problematic cases.
|Information on this site is provided for informational purposes and is not meant to substitute for the advice provided by your own physician or other medical professional. You should not use the information contained herein for diagnosing or treating a health problem or disease, or prescribing any medication. You should read carefully all product packaging. If you have or suspect that you have a medical problem, promptly contact your health care provider.
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