Getting to know your A's, B's and C's

Starting dose 20mg of Fluoxetine

Can titrate up to a maximal dose of 60mg

Note that the major side effects include:
- no improvement for first few 2 weeks
- first few days of feeling a bit odd
- nausea and vomiting
- insomnia
- may experience worsening of depression or suicidality

1. Medical - Abx for acute episodes, long term abx for prophylaxis
2. General management - double micturition, hygiene
3. Surgical - avoid if possible!

Investigate any child for Vesicourereric Reflux (VUR) and subsequent Reflux Nephropathy if:
First UTI in a boy
Second UTI in a girl

Along with biochemistry, we can image with
- IVP (“gold standard”)
- Renal US
- CT
- DMSA (excellent for visualizing hard to see renal scarring)
- other imagine modalities

We are looking for signs such as small kidneys, scarring, calyceal changes, etc

Note that hypertension in children is a LATE SIGN of Reflux nephropathy

Source - Prof Agar’s “Nephrology Made Easy” (comprehensive yet easy to read and understand guide to nephrology)

Oesophageal atresia may accompany the VATER association:
Vertebral anomalies
Anal imperforation
Tracheo-Esophageal fistula
Radial anomaly (limb deformity)
Renal anomaly

Expect a 2 point drop in MMSE score each year in the patient with dementia.