CASE 40 - Child With Diarrhea

Question 1

How sick is my baby?

Answer 1

It is hard for me to give you an accurate answer over the phone. I would like you to bring your baby here so that I can examine her and perhaps run some tests.

After that, I should be able to give you a more accurate assessment.

Question 2

Specific Qs:

Answer 2

1. Frequency/description of bowel movements.
2. Blood in stool.
3. Relationship to oral intake.
4. Previous regular bowel movements.
5. Activities.
6. Awake and responsive.
7. Number of wet diapers.
8. Dry mouth or sunken soft spot over the head.
9. Tx tried.
10. Vigorous cry ==> Her cry is weak.
11. Recent URI.
12. Cough, pulling ear, or crying when urine is passed.

Question 3

DDx:

Answer 3

1. Viral gastroenteritis.
2. Bacterial diarrhea.
3. Malabsorption.
4. UTI.
5. Intussusception.
6. Bacteremia.

Question 4

Workup:

Answer 4

1. Rotavirus enzyme immunoassay/norovirus PCR.
2. Electrolytes.
3. Stool leukocytes, culture, ova and parasitology, and pH.
4. UA.
5. AXR.
6. Blood cultures.