Vomiting and Diarrhea in child

Age: ‍ ‍monthsyears old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of vomiting and diarrhea

Vomiting episodes occurred ‍ times ‍per dayoverall

Vomitus contains ‍undigested foodbileblood

Diarrhea occurred ‍ times ‍per dayoverall, described as ‍wateryloose

Worsening factors: ‍none

Alleviating factors: ‍nonedietary modifications, ‍effectiveineffective



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

‍abdominal pain, ‍diffuse, ‍dull, ‍mild

‍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



Contributing factors:

‍similar symptoms in close contacts

‍recent travel

‍recent hospitalization

‍untreated water drinking

‍suspected food poisoning

‍undercooked meat

no history of: ‍irritable bowel syndrome, ‍Crohn's disease, ‍ulcerative colitis, ‍celiac disease, ‍food intolerances

no use of: ‍antibiotics, ‍laxatives, ‍anti-acid, ‍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:

‍Acute gastroenteritis ‍likelysuspectedpossible

DDx: acute gastroenteritis, food poisoning, food intolerance, medication side effects, appendicitis, inflammatory bowel disease, celiac disease, lactose intolerance, intestinal obstruction, metabolic disorders, toxic ingestion, urinary tract infection, pancreatitis, hepatitis, peptic ulcer disease, pyloric stenosis, intussusception, Hirschsprung disease, COVID-19





PLAN:

Investigations:

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

- Stools: ‍bacterial culture, ‍parasitic culture, ‍C. difficile toxin

- Abdominal ultrasound

Treatments:

- Encourage oral hydration

- Oral rehydration therapy

- Normal saline IV fluids ‍1020 ml/kg bolus

- ‍Antiemetics

- Avoid dairy and fatty foods

Further care:

- Return if symptoms worsen or if child becomes lethargic