A 2-year-old previously healthy male presented to the emergency department (ED) with cough, rhinorrhea, and nonbloody nonbilious emesis. Parents also reported he seemed tired the last couple of days. He has been on Bactrim treatment for recently diagnosed urinary tract infection. Family history is negative for anemia and transfusions.

In the ED, respiratory rate was 32 breaths/minute and oxygen saturation 76% on room air. Other vital signs were stable. The physical exam was significant for tachypnea and oral cyanosis. Even with supplemental oxygen, the maximum oxygen saturation attainable was 80%. Take the quiz.

Chandni Dargan, MD and Mukta Sharma, MD MPH
Division of Pediatric Hematology Oncology
Children’s Mercy, Kansas City, MO

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