Vomiting and Diarrhea in child

HISTORY:

Vomiting and diarrhea for ‍ ‍hoursdays

Vomiting episodes: ‍ times ‍per dayoverall

Vomitus: ‍undigested foodbileblood

Diarrhea episodes: ‍ times ‍per dayoverall, described as ‍wateryloose

Treatments tried: ‍nonedietary modifications, ‍effectiveineffective

‍abdominal pain

‍hematochezia

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍lethargy

‍irritability

‍rash

‍decrease in fluid intake

‍decrease in urine ouput

‍decrease in appetite



EXAM:

General appearance: ‍well-appearing

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

Head: fontanelles ‍soft, ‍normocephalic

Eyes: -R: ‍normal, -L: ‍normal, ‍

Ears: -R: ‍normal, -L: ‍normal

Throat: ‍normalrednessexudate

Mouth: ‍normal

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Genital: ‍normal, testicles ‍normal, penis ‍normal, Tanner stage ‍

Skin: ‍no rash

Extremities: ‍normal, ‍normal pulses, cap refill ‍< 3 sec> 3 sec



ASSESSMENT:

‍Acute gastroenteritis ‍likelysuspectedpossible

DDx: ‍



PLAN:

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

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

- Abdominal ultrasound

- Encourage oral hydration

- Oral rehydration therapy

- Normal saline IV fluids ‍1020 ml/kg bolus

- ‍Antiemetics

- Avoid dairy and fatty foods

- Return if symptoms worsen or if child becomes lethargic