Siblings w/ vomiting

Question 1

what is the recommended mode of tx for severe dehydration

Answer 1

volume restoration via bolus therapy w/ an isotonic saline solution

(normal saline for pyloric stenosis bc of high chloride content)

Question 2

What do you look for/monitor in a pt w/ concerns for severe dehydration and how do you rehydrate with IVF for severely dehydrated kids?

Answer 2

Looking for thready pulse, lethargy, oliguria/anuria

Rehydration therapy:

1. LR or NS in 20mL/kg boluses until urine output comes back
2. Then 100 mL/kg oral rehydration over 4 hours.

If child is not tolerating PO you can do D5 half NS at 2x maintenance fluid subbed for oral rehydration.

Question 3

presentation of GERD

Answer 3

Reflux w/ overfeeding may have forceful vomiting

severe esophagitis can lead to blood-streaked emesis

Question 4

volvulus presentation

Answer 4

blood in the stool and severe abdominal pain

Question 5

Intussusception presentation

Answer 5

currant jelly stool, abdominal exam shows sausage-like mass due to telescoped bowel

telescoping on US

Question 6

What is the workup for infectious gastroenteritis

Answer 6

Wright’s stain for fecal leukocytes

Rotazyme test

Stool culture and sensitivity

Stool guaiac

Stool C. diff

Question 7

how to monitor hydration status

Answer 7

skin turgor

touch

lips

eyes

tears

fontanelle

urine output

cap refill

pulse rate and quality

Question 8

Differences between mild and moderate dehydration

Answer 8

mild dehydration: basically all signs are normal

moderate dehydration has: tenting, dry mucous membranes, deep set eyes, soft fontanelle, decreased urine output, cap refil =2seconds, increased pulse, weak pulse

Question 9

differences between moderate and severe dehydration

Answer 9

severe dehydration has CLAMMY SKIN, parched/cracked lips, sunken eyes, SUNKEN fontanelle, NO URINE output, capillary refill greater than 3 seconds, increased pulse rate and feeble/impalpable pulse quality