Dr. Faisal Abdul Karim Malim
Pediatrics
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hello doctor,
Our daughter, who recently turned 16, has been having some random, sporadic episodes of transient fatigue and lightheadedness for the past three months. She has no other symptoms, including no weight loss, no headaches, no fever, and no lymphadenopathy. We mentioned it to our regular Pediatrician, and they did not think of it.
Her past medical history is unremarkable, except for she was diagnosed with a mild mitral valve prolapse two years ago, which was deemed insignificant with no follow-up suggested. She also received a booster shot for MMR about 3.5 weeks ago. I had some comprehensive lab blood tests done last week on her, which I will add to this note.
She has a normal white blood cell count, C-reactive protein, sedimentation rate, HbA1c, but I noticed that her absolute monocytes were mildly low. Did you think this was significant, or anything else was of any concern? She has high cholesterol, most likely due to her vegetarian diet and her regular cheese and bread consumption.
She is not on any medications, just vitamins, including a small daily dose of zinc gummy. She has been taking a Pediatric vitamin with iron, too, as she is a vegetarian. She eats zero meat, so I asked her to take some. She also gets some iron from her foods.
Hello,
Welcome to icliniq.com.
I have gone through your query and the reports (attachment removed to protect patient identity). Nothing significant was noted except that the cholesterol levels are quite high.
I would suggest the following:
1. Daily exercise, walking, or aerobic activity for atleast an hour.
2. Reduce the intake of cheese and bread.
3. Please check the child's blood pressure on three different occasions at three different time intervals to see if there is hypertension. A single reading of 120/80 is acceptable for a child this age.
4. After doing the above modifications, I would suggest repeating a lipid panel for the child.
The reason for fatigue may be either due to chronic fatigue syndrome or, to some extent, due to the cholesterol causing high blood pressure (intermittently) leading to lightheadedness during such periods. In either case, exercise and dietary modification is a must.
Patient's Query
Thank you doctor,
I will tell her to reduce her cheese and bread intake and exercise more. Do you think the mildly low monocyte level (166, normal is between 200-900) is nothing too serious? All her other WBC labs looked normal. Her WBC was 6.4 (normal), and neutrophils, lymphocytes, eosinophils, basophils were all normal. But RBC count (5.14) and hematocrit (46.8) were slightly higher than the top normal range. C-reactive protein and sed rate were completely normal too. I also noticed her pulse is sometimes a little low. Last night it was 56. And then, later in the evening, it was 62. What common things could cause that?
Hello,
Welcome back to icliniq.com.
Pulse rate of 56 occasionally is acceptable. However, an ECG should be done to rule out any issues. Such low pulse rates are common in young children. It is considered as athletic heart rate (at rest).
The mildly low monocyte levels are acceptable. Other labs (apart from cholesterol) are normal too.
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Pediatrics
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