Case 40 - 6-month-old girl with diarrhea

Question 1

Gathering information

Answer 1

Onset
Progression
Fever
Color
Consistency
Blood or mucus
Change in number of wet and dirty diapers
Last wet diaper
Change in feeding habits
Pain with urination or defecation
Sunken fontanelle/dry mouth
Respiratory distress (grunting, flaring of nares, belly breathing)
Abdominal distention
Activity level (playful, lethargic, awake and responsive, drowsy)
Vigorous cry
N/V
Cough
Rash
Ear discharge, tugging at ear
Convulsions
Formula or breastfed
Sick contacts
Daycare
Birth history (maternal drug or alcohol use, pregnancy complications, preterm birth, delivery complications, first stool within 24 hours)
Recent sicknesses
PMHx
PSHx
FHx
Social Hx (safe at home)
Health maintenance (last pediatrician visit, vaccinations)
Eating habits
Development (height, weight, milestones)
Medications
Drug allergies

Question 2

Closure

Answer 2

I’m concerned that your baby is dehydrated, since she hasn’t urinated since yesterday and isn’t feeding well
We do not want to jeopardize your baby’s health, so it’s best to have the baby come in today
Social worker can help you find transportation to the clinic
Do you have any questions for me?

Question 3

Differential diagnosis

Answer 3

Viral gastroenteritis
Bacterial diarrhea
Malabsorption

Question 4

Diagnostic work-up

Answer 4

CBC with differential
Stool leukocytes, culture, ova and parasites, and pH
Rotavirus enzyme immunoassay and norovirus PCR
Electrolytes
UA
AXR
Blood culture