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Clinical Cases

Acute Lung Infection in a Paediatric Patient – Role of Constitutional Remedy with Miasmatic Depth

Dr. Rakesh Gupta et. al. share a case of acute lung infection in a boy of six. Obstinate, restless, intolerant of criticism and precocity were among the symptoms leading to an anti-miasmatic remedy.

Treating a child during acute respiratory illness like viral pneumonia with high grade fever is a challenge for homeopathy. High grade fever can induce febrile convulsions and also lead to delirious states in a child. Case taking in a child requires special skills, often the portrait of the disease can only be completed with the help of the history received from parents and via observation of the patient.

The prescription should be based on the characteristic symptoms which are the expressions of the disease state of susceptibility. In a paediatric patient, the state of susceptibility is high until there is evidence of immunosuppression or suppressive treatment or any congenital illness or irreversible diseases. In a high state of susceptibility, the most characteristic symptoms are projected. The physician should keenly observe these manifestations for prescribing the  simillimum.

Case History

This is 6- year-old male child suffering from respiratory infection. The patient presented with complaints of fever, cold and cough, vomiting since 3 days, recorded temperature ranging from 100F to 103F. He also had sleeplessness along with other general symptoms like loss of appetite and weakness.

Cough worse after eating followed by vomiting. So patient was avoiding eating with fear of vomiting. Craving for cold food and drinks but that aggravates R.S complaints. Thirstless3+.

Sleeps – on abdomen3+. Weight- 16.8 kg.  Thermally -Hot patient.

Kali carb 200 prescribed on OPD basis without any relief So patient was admitted.

Mental  characteristiscs:

Contradiction intolerant2+  He expects others to talk politely to him. If ordered to do something he gets annoyed. Intelligent child and very good at his studies. Mature in talking. He is also very obstinate about the type of game he wants to play. He doesn’t allow younger cousin at his house as she dictates her wish to play a game which he is not liking.  Parents said that he has tendency to catch cold every 15 days and it requires bronchodilators and antibiotics.

21-7-22
Hemoglobin 14.1g/dl
RBC 5.09 million/cumm
WBC 13000/cumm In age group of 6 years to 15 years

WBC normal range  4800 to 10800.

Neutrophils 74%
Lymphocyte 13 %  L
Absolute Neutrophils 9620/cmm H
Absolute Eosinophils 780/cmm   H
Absolute Monocytes 910/cmm   H
Dengue NS1 Antigen Negative
Dengue IGM Negative
Malaria parasite antigen Negative
CRP 10.4mg/L

X ray Chest PA view 22/7/2022

Visualized lung fields show increased vascular markings with patchy haziness Bilaterally. Suggestive of Viral Pneumonia  HRCT is suggested for further evaluation if clinically  indicated.

On Examination-

Pulse -90 /min

Temp-  98.0 F (11.00 PM) on arrival (Parents gave anti pyretic before their house)

R.S – Generalised wheeze and scattered Crepts more at LLZ.

DIAGNOSIS:- VIRAL PNEUMONIA with Secondary Bacterial Infection.

 CLASSIFICATION OF THE DISEASE:  ACUTE INDIVIDUAL DISEASE WITH FULLY DEVELOPED SYMPTOMS

Acute Disease totality:

  • Mind-Dullness -heat during
  • Stomach –Thirstless-heat during
  • Stomach –Vomiting Cough during
  • Extremities –Pain – fever during agg.

Chronic Constitutional Totality:

  • Obstinate in Children
  • Restlessness in children
  • Contradiction, intolerant of children
  • Precocity in children
  • Cold take, tendency to
  • Extremity Pain Fever during.
  • Repeated tendency to get cold and coryza.

 

TUBERCULINUM CHILD

Tuberculinum: They are very mature for their age, active, intelligent and irritable especially if they do not receive things they desire. Usually playful, restless, wants to change the position, desires travelling and constant change in life and wants to do different things. Heedless and reckless.

Remedy Selection:

Tuberculinum 10 M Single Dose

Different Methods of prescribing

Acute medicines are used to treat the illness

Constitutional medicines are used

Intercurrent remedy or Anti-miasmatic remedy

Intercurrent remedy followed by constitutional

Pathological remedies

Tissue remedies or organ specific remedies

In this case the constitutional remedy covers the miasmatic depth and helps in the case management.

Criteria for follow up:

1.Fever      2. Appetite       3.Sleep     4. Thirst      5. Nausea     6. Vomiting

 

21/7/22

4 PM

Vomiting-  One Episode but child was Dull.

O/E – R.S-Crepts ++ in LUL and LLZ

Pulse – 114/min

Rx

Kali Carb 200 1st Dilution every 2 hrly.

22/7/22

8 AM

Temp – 101.6F

Cough –SQ-

Admitted on 22nd July 2022

started with IV Fluid

Isolyte P  over 12 hrs to avoid dehydration.

Kali Carb 200 1st Dilution every 2 hrly.

22/7/22

10.00 AM

Temp -103.7F

Cough < eating while

Cold air agg

Probable cause- feet getting cold

Observation on SL
22/7/22

4.00 PM

Case restudied

Dullness fever during

Thirslessness fever during

Cough two paroxysm

Cough short bouts

Cough eating agg

Cough lying down agg

Temp -104 F

Changed the medicine

Rx Tub 10 M (1P)  given

 

 

 

6.00 PM  Temp – 102.9F Rx

Tub 10 M 1st dil ½ hourly

11.00 PM  Temp – 103F Rx

Tub 10 M 1st dil  ½ hourly

 

23/7/22

4 PM

Cough ->>>-

Dullness->>-

Appetite  is increased.

Rx

TUB 10 M 1st dilution every ½ hourly

 

24/7/22

 

Cough ->>>- Fever >>>

Dullness->>- No Vomiting

Rx

TUB 10 M Ist dilution every 30 mins to 45 mins.

Investigations 24-7-22
Hemoglobin 12.4g/dl
RBC 4.40million/cumm
WBC 11100/cumm
Neutrophils 68%
Lymphocyte 25%
Absolute Neutrophils 7500/cumm
Absolute Eosinophils 222/cumm
Absolute Monocytes 555/cumm

 

25/7/22

 

Cough ->>-, No Fever last 24 hrs.

Overall patient is better.

No Nausea and no vomiting.  R.S – O/E– No Crepts

Rx

TUB 10 M 1st dilution every 2 hrly

 

01-08-22
Hb  13.1
RBC   4.67 million/cumm
WBC  10950/Cumm

WBC count reduced from 13000 to 10950

Neutrophils  43.7
Lymphocyte  49.3
Absolute Neutrophils  4785/ cumm
Absolute Eosinophils   110/cumm
Absolute Monocytes   624/cumm

Follow after 1 week of discharge

Patient is over all much better, No fever, No Cold and No cough

 Rx:  Tub 10 M first dilution alternate nights for 10 days

Follow up after 2 weeks of discharge

Patient is much better

Rx: SL 200 4 pills 4 times a day x 15 days.

CONCLUSIONS AND LEARNING:

  1. Childhood respiratory illnesses like pneumonia, LRTI, bronchiolitis can be treated.
  2. It often begins with viral infection of the lungs due to seasonal change but it can be secondarily infected as confirmed after high WBC count.
  3. Disease often travels from general to particular known as localization of the disease.
  4. Dilution technique of prescription delivers immediate relief.
  5. In this case anti miasmatic remedy was used as the constitutional remedy.
  6. Team work and acute case management is the most important aspect to provide cure.
  7. Relevance of temperature monitoring and temperature graph for understanding remedy’s response.

Acknowledgement: 

We thank Dr Mohanbhai Patel, Chairman, The Homoeopathic Education Society (Smt. Chandaben Mohanbhai Patel Homoeopathic College),

Shri Nayan Patel, Vice Chairman, The Homoeopathic Education Society (Smt. Chandaben Mohanbhai Patel Homoeopathic College),

Dr Asmita Parikh; General Secretary, The Homoeopathic Education Society (Smt. Chandaben Mohanbhai Patel Homoeopathic College) and Dr Parizad Damania- Principal, Smt. Chandaben Mohanbhai Patel Homoeopathic College for the encouragement, support and hospital infrastructure.

Bibliography:

  • Clarke JH. Dictionary of Practical Materia Medica vol-1, B Jain Publishers Pvt Ltd, Reprint edition 1992, 138-145.
  • William Boericke, Boericke’s New Manual of Homeopathic Materia medica with Repertory, B Jain Publisher (P) Ltd, Third Revised and Augmented Based on 9th Edition, 42nd Impression 2018, 61-64.
  • Phatak SR. Materia Medica of Homoeopathic Medicines, 2nd Edition 22nd impression: B. Jain publication Ltd., 2018, 61-66.
  • Lectures on Homeopathic material medica, ed: 1st Indian edition, James Tyler Kent (A.M., M.D), B Jain publication co Ltd, 115-122.
  • Keynotes and Characteristics with Comparisons, Ed: 2nd, H.C. Allen, M.D, IBPP, New Delhi, Pg : 28,29,121,122,123,219,220,221,239,240,241,242.
  • Comparative Materia Medica, E. A. Farrington, Jain Publishing Co, New Delhi, Pg 10, 158, 186.
  • ICR, Symposium Part 1, Are A, B and C, 3rd Edition, M. L. Dhawale, Published by Dr. M.L. Dhawale Memorial Trust, Plate 16.
  • Repertory of the Homoeopathic Materia Medica, Indian Edition, Reprinted from Sixth American Edition, J.T. Kent, Indian Books and Periodicals Publishers, New Delhi, 267.
  • Bed Side Clinical Prescribing in Homeopathy, 2nd Edition, 4th Impression, Dr. Farokh Master. B Jain publication (P) Ltd, Noida, UP (India), page 65.

About the author

Rakesh Gupta

Dr. Rakesh Gupta MD(Hom) Practice of Medicine, MBA (HCS), FLP (KPMG), SCR. HOD Forensic Medicine and Toxicology, Smt Chandaben Mohanbhai Patel Homeopathic Medical College, Mumbai, India. President, Satva Homeopathy and Satva Charitable Sanstha, Mumbai, India.

1 Comment

  • Thank you Dr. Gupta for presenting this excellent, well managed case. It demonstrates the best of homeopathic practice.

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