Acute Vomiting and Nausea in child

Age: ‍ ‍monthsyears old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍hourday history of ‍nausea and vomiting

Vomiting episodes occurred ‍ times ‍per dayoverall

Vomitus contains ‍undigested foodbileblood

Occurs most frequently during the ‍dayafter meals

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍diarrhea, ‍ episodes ‍per day, ‍

‍constipation

‍hematochezia, ‍bright reddark red, ‍around stoolsmixed with stools, ‍withwithout clots

‍bloating

‍weight loss, ‍ ‍lbskg over ‍ ‍weeksmonths, ‍unintentionalintentional

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍fatigue

‍lethargy

‍irritability

‍rash

‍decrease in fluid intake

‍decrease in urine ouput

‍decrease in appetite

‍dysuria

‍frequency

‍foul-smelling urine

‍flank pain

‍headache, ‍diffuse, ‍persistentintermittent, ‍pressurethrobbing, ‍mild

‍vertigo

‍anxiety



Contributing factors:

‍similar symptoms in close contacts

‍recent travel

‍untreated water drinking

‍suspected food poisoning

‍undercooked meat

‍heavy use of cannabis

no history of: ‍migraine, ‍peptic ulcer disease, ‍gastroesophageal reflux disease

no use of: ‍antibiotics, ‍chemotherapy, ‍new medication





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Head: fontanelles ‍soft, ‍normocephalic

Eyes: conjunctiva/sclera ‍normalinjection, lids/lashes ‍normalerythema, ‍PERRL, extraocular movements ‍intact, red reflex ‍present, corneal light reflex ‍symmetrical, fix and follow test ‍intact

Ears: tympanic membranes ‍normal ‍, auditory canal ‍ on ‍rightleft, hearing ‍intact

Throat: ‍normal, ‍palate intact, ‍redness

Mouth: mucosa ‍normal, dentition ‍normal

Neck: ‍normal, ‍lymphadenopathy, ‍nuchal rigidity, ‍torticollis, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Genitourinary: external genitalia ‍normal, testes ‍descended, penis ‍normal, Tanner stage ‍

Skin: ‍rashlesions on ‍

Extremities: ‍normal inspection, ‍joints ‍normal, ‍limited ROM, ‍normal spine, Barlow ‍negative, Ortolani ‍negative, ‍normal pulses, cap refill ‍< 3> 3 sec

Neurologic: cranial nerves ‍grossly intact, overall motricity ‍normal for agelimb weakness, muscle tone ‍normal for age, gait ‍appropriate for age, reflexes ‍intact 2+

Mental status: ‍alert, ‍, reactive to ‍





ASSESSMENT:

‍Gastroenteritis ‍likelysuspectedpossible

DDx: gastroenteritis, food poisoning, appendicitis, intestinal obstruction, urinary tract infection, concussion, intracranial pressure, metabolic disorders, medication side effects, toxin exposure, motion sickness, migraine, pyloric stenosis, intussusception, pancreatitis, hepatitis, diabetic ketoacidosis, adrenal insufficiency, sepsis, meningitis, COVID-19





PLAN:

Investigations:

- Blood work: ‍CBC, ‍lytes, ‍creatinine, ‍glucose, ‍LFTs, ‍albumin

- Stools: ‍bacterial culture, ‍parasitic culture

- Abdominal ultrasound

Treatments:

- Oral rehydration therapy with Pedialyte

- Pediatric antiemetics

- Avoid dairy and fatty foods

Further care:

- Return if symptoms worsen or if child becomes lethargic