Diarrhoeal and Vomiting Illnesses

Question 1

What is the ddx for a 6/52 baby that presents with vomiting?

Answer 1

Benign = physiological reflux

Pathological =

• sepsis (UTI, pneumonia, meningitis)
• GI (PYLORIC stenosis, volvulus, intussusception, incarcerated hernia)
• CNS (head injury, meningitis, tumour)
• Metabolic (hyperglycaemia, hyper/hypoNa, inborn errors in metabolism)
• Endocrine (adrenal insufficiency (CAH))
• Trauma (NAI, shaken baby)
• Toxins (accidental, deliberate)

Question 2

What are the complications of a vomiting illness in a baby?

Answer 2

Dehydration, electrolyte abnormalities, shock, aspiration, hypoglycaemia

Question 3

If a child presents with vomiting but no diarrhoea, what conditions should you consider?

Answer 3

Sepsis, UTI, CNS disease, DKA

Question 4

Describe the patient with severe dehydration.

Answer 4

Severe (>7%), CRT >3 seconds, mottled skin, signs of shock (irritability, reduced conscious level, tachycardia, hypotension), reduced skin turgor, Kussmal respirations

Question 5

What signs are unreliable in dehydration?

Answer 5

Dry mucous membranes, lethargy, sunken eyes

Question 6

What are the clinical features of a child with moderate dehydration?

Answer 6

CRT >2 seconds, increased RR and reduced skin turgor.

Typically 4-6% dehydrated.

Question 7

How do you manage children with moderate dehydration?

Answer 7

SSU, rapid rehydration protocol. 25-50 ml/kg ORS via NGT over 4 hours.

Ondansetron for ongoing vomiting + slow the rate down. If fails –> management as severe dehydration.

Question 8

How do you manage severe paediatric dehydration?

Answer 8

Normal saline bolus 20 mg/kg. Treat hypoglycaemia with 2-5 ml/kg of 10% dextrose.

Ongoing fluids: 0.9% + 5% dextrose using the 4/2/1 rule.