15- vomiting

Question 1

manage mild-moderate dehydration

Answer 1

oral rehydration therapy

50-100 mL/kg of oral rehydration over 24 hours
(small vol given frequently)
10 ml/kg oral given for each diarrhea stool
2 ml/kg for each additional emesis

Question 2

manage mod-severe dehydration

Answer 2

IV bolus -20 ml/kg isotonic, non-dextrose (saline or lactated ringers) until improved

Question 3

differential for vomiting + dehydration in 6 week old

Answer 3

GERD
viral gastroenteritis
malrotation +- volvolus
intususpeption
inborn errors of metabolism
pyloric stenosis
CNS disease- hydrocephalus, neoplasm, trauma
UTI

Question 4

labs to confirm pyloric stenosis

Answer 4

1. pylorus US
2. Upper GI contrast study “string sign”

Electrolytes

Question 5

treat pyloric stenosis

Answer 5

before surgery: Repeated boluses of normal saline or lactacted Ringers solution, in 10-20 ml/kg aliquots, until mild dehydration or normal fluid status.

after surgery; Rehydration either orally or with ongoing IV fluids.

Question 6

surgery for pyloric stenosis

Answer 6

pyloromyotomy :
pyloric muscle is split (divided) without cutting through the mucosa.
via a small upper abdominal incision or laparoscopically.

relatively short and simple and have very low complication rates. return home in couple of days

Question 7

blood streaked emesis think in 6 month old think…

Answer 7

GERD

Question 8

work up for infectious diarrhea

Answer 8

stool Wright’s stain for fecal WBCs- bacteria

Rotazyme test- rotavirus

stool sample for culture and sensitivity.

stool guaiac (for occult blood)

stool C. diff toxin.