Vomiting And Diarrhoea Flashcards
A 18 month child presents to A&E vomiting and having had severe loose stools. What questions would you ask in the history?
How long has this been going on for? How did it start? Did anything trigger it? What has the child eaten over the past couple of days? Is anyone else around them unwell?
Do they have a fever?
Do they have any abdominal pain?
Do they have any rashes?
The patient’s mother reports that the vomiting and diarrhoea started within the last 24 hours and she is worried as her child is not themselves.
What would you look for on examination?
Signs of Dehydration- altered responsiveness, sunken eyes, tachycardia, tachypnoea, reduced skin turgor
Abdominal exam
HR 175 (82-149) RR 50 bpm (20-40) T 37.5 BP 90/50 On examination the child is irritable and has reduced skin turgor
What would you like to do next?
Give IV replacement fluids- this child is clearly very unwell and needs urgent replacement of 100ml/kg as well as maintenance fluid requirements :
For every kg up to 10kg = 100ml/kg/day.
For every kg between 10 and 20kg  = 50ml/kg/day.
For every kg over 20kg = 20ml/kg/day
If the child was less dehydrated you can give 50ml/kg as well as maintenance fluids.
Should this child be given antibiotics?
No, only if:
- suspected sepsis
- younger than 6 months with salmonella
- C difficile pseudomembranous enterocolitis
- giardiasis
What is the most likely diagnosis in this case?
Gastroenteritis
What is the most common cause of gastroenteritis in this age group?
Rotavirus
Another patient 3 years old, presents this time with bloody diarrhoea and profuse diarrhoea. What aetiology do you suspect?
Bacterial infection
The child is admitted for monitoring and fluid replacement. The next his blood results come back showing deranged kidney function, thrombocytopenia and anaemia, what is the likely cause?
Haemolytic Uraemic Syndrome
How is haemolytic uraemic syndrome managed in general terms?
Early supportive therapy including dialysis if required.
