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- 2. General Data Name R.C Age/Gender 1 year and 4 months / Female Nationality Filipino Religion Iglesia ni Cristo Home Cavite
- 4. History of Present Illness 4 days PTA: ○ 2 episodes of vomiting previously ingested milk ○ 1 episode of yellow watery stool ○ No fever, cough or colds 3 days PTA: ○ 2 episodes of vomiting previously ingested food and milk ○ 2 episodes of yellow watery stool ○ Consult was done at CGHMC ER ❏ Acute gastroenteritis, mild dehydration ❏ Discharged ❏ THM: Pedialyte, Zinc Sulfate drops 1ml OD, Erceflora 1 vial BID for 5 days
- 5. History of Present Illness On the Interim: ○ 5x mushy light green stools ○ Zinc sulfate and Erceflora given as due, Pedialyte was not Few hours PTA: ○ 4x loose bowel movement ○ Weak looking, irritable, incessant crying prompted consult to ER
- 6. Review of Systems General (+) weight loss (3 kg in 2 weeks) HEENT (-) eye redness, (-) eye discharge, (-) ear discharge, (-) ear pain Cardiac (-) cyanosis Respiratory (-) cough, (-) colds Genitourinary (-) hematuria Musculoskeletal (-) limitation in range of motion Neurologic (-) seizure Hematologic (-) easy bruising, (-) pallor, (-) bleeding
- 7. Past Medical History ➢ Patient had similar illness in the past ○ 3x watery stools ■ Hidrasec, with relief ■ Changing of milk brands ➢ No past hospitalization ➢ No past surgeries
- 8. Family History ✓ Hypertension: maternal ✓ Diabetes: maternal ✓ Hyperthyroidism: paternal ✓ Cancer: maternal ✓ PTB: aunt, resolved ✓ Asthma: mother ✓ Allergies: mother
- 9. Personal and Social History ● Patient lives with her mother, who is working as a clinical nurse, with 5 other people, her maternal grandfather and grandmother, uncle and 2 aunts. ● A nanny comes by to take care of her when her mom goes to work. They live in a bungalow house, adequately ventilated, drinks distilled water (Wilkins) only, her family’s drinking water comes from the water station. T ● The patient still needs to be fed by her mom. Garbage is collected every other day
- 10. Birth and Maternal History ➔ Live, full term, to a then 33 year old G2P1 mother at a local hospital. She had regular prenatal checkups with an OB GYN. Mother had UTI during her first trimester, taken unrecalled antibiotics which resolved. 2nd and 3rd trimesters were unremarkable. ➔ Cesarean delivery, birth weight of 2.94 kg, no fetomaternal complications
- 11. Growth & Developmental History
- 12. Nutritional History ● Never breastfed ● Formula milk: ○ Bear brand ○ Nestogen lactose free ○ Lactum ○ AL110 ● Complementary feeding ○ Started at 6 months ● Regular table food ○ Started at 9 months ● Picky eater ○ Normal: rice, potato, yolk, cerelac ○ Preference: simple pastries ○ Snacks: morning, afternoon 24 hour recall ● Breakfast ○ 1 slice of bread, 3 biscuits ● Lunch ○ Milk ● Dinner ○ Milk ● Milk ○ 5-8 bottles ● Water ○ 7 oz
- 13. Immunization History Administered ● BCG ○ Hospital ● Hepatitis B ○ 1st dose - Hospital ○ 2nd to 4th dose - Health Center ● DPT-Polio-Hib ○ 1st to 3rd dose - Health Center ● OPV ○ 1st to 3rd dose - Health Center ● PCV ○ 1st to 3rd dose - Health Center Not administered ● Rotavirus ● Measles ● MMR
- 14. Anthropometrics Weight: 9.3kg Height: 82cm BMI: 13.8 kg/m2
- 15. Anthropometrics Weight: 9.3kg Height: 82cm BMI: 13.8 kg/m2
- 16. Anthropometrics Weight: 9.3kg Height: 82cm BMI: 13.8 kg/m2
- 17. Anthropometrics Weight: 9.3kg Height: 82cm BMI: 13.8 kg/m2
- 18. Anthropometrics Weight for age 0 Length for age 0 Weight for length Below -1 BMI for age Below -1 Interpretation: Normal
- 19. Physical Examination General Awake, weak looking, not in cardiorespiratory distress Vital Signs HR 132 RR 24 T 36.4 O2 sat 98% at RA Skin (-) pallor, (-) cyanosis, normal skin turgor, CRT <2secs HEENT Symmetrical facial features, slight sunken eyeballs, dry lips, moist oral mucosa, non hyperemic tonsils, (-) cervical lymphadenopathies Respiratory Symmetrical chest expansions, clear breath sounds, (-) wheezes, (-) retractions Cardiovascular Adynamic precordium, normal rate and regular rhythm, (-) murmurs Gastrointestinal Soft, non tender, non distended, hyperactive bowel sounds Extremities Pulses full and equal, (-) edema, (-) inflammation
- 20. Salient History Subjective Objective Pertinent Positive ● 5 days loose bowel movement (11x) ● 2x vomiting episodes: previously ingested food Pertinent Negatives ● Non bloody, nonmucoid, no melena ● Nonprojectile, non bilious, no hematemesis ● No abdominal pain ● No fever ● Slightly sunken eyeballs ● Dry lips ● Hyperactive bowel sounds
- 21. Primary Working Diagnosis Acute Gastroenteritis with moderate signs of dehydration
- 22. Differentials Salient Features Viral Gastroenteritis Amoebiasis Lactose Intolerance ● 1y/4mo old ● Loose bowel ● movement (11x): mushy light green ● Vomiting episodes (2x): previously ingested food ● Non bloody, non mucoid, no melena ● Weak-looking and irritable ● Weight loss ● (-) Abdominal pain ● (-) Fever ● (-) Rotavirus vaccine ● Rotavirus most common pathogen ● Watery Diarrhea, vomiting, fever ● Dehydration ● Weight loss ● Young age associated with increased risk for severe disease ● Most cases asymptomatic ● Incubation period of 2-4 weeks ● Colicky abdominal cramps or pain, diarrhea associated with tenesmus ● Vomiting and fever uncommon ● Commonly manifests at 3 y/o and up ● Abdominal pain, bloating, flatulence, nausea or diarrhea after milk ingestion ● Symptoms present 30 minutes to 2 hours after milk ingestion
- 23. Admitting Orders Diet As tolerated Laboratories CBC with platelet count Serum Electrolytes Fecalysis Urinalysis Stool culture/sensitivity Therapeutics Zinc sulfate oral drops 1 mL PO OD IV Fluids D5 0.3 NaCl 1L x 45cc/hr Monitoring VS q4. Input and output
- 24. Laboratories CBC WBC 9.7 Hgb 116 Hct 0.350 Plt 364 Segmenters 59 Lymphocytes 26 Monocytes 15 Serum Electrolytes Na 133 K 3.9 Cl 103 Fecalysis Color Light Brown Consistency Mucoid Parasitic Ova None E. Histolytica Cysts Negative RBC 1-2/hpf Pus cells 0-2/hpf Yeasts Few Fat Globules Few
- 26. Definition ★ Inflammation of the gastrointestinal tract ★ Illness of <14 days
- 27. ★ Virus ○ Rotavirus (most common), Calicivirus (norovirus, sapovirus) ★ Bacteria ○ Nontyphoidal Salmonella, Shigella, Campylobacter, Yersinia, E. Coli (STEC, EHEC, ETEC, EPEC, EIEC), C. Difficile, V. Cholera (O1, O139), Foodborne (B. Cereus, S. Aureus, C. Pefringens ★ Parasites ○ Giardia, Cryptosporidium, Cyclospora, Entamoeba Etiolology
- 28. Pathogenesis
- 29. ★ Diarrhea ○ Passage of 3 or more abnormally loose or liquid stool per day ★ Vomiting ★ Fever ★ Abdominal pain Clinical manifestation
- 30. ★ Fecalysis: bloody, chronic, fat malabsorption ★ Urinalysis: dehydration (sp >1.02) ★ Stool CS: bloody (bacterial) ★ CBC w/ plt: systemic infection ★ Serum electrolytes: Na, K, C Diagnostics
- 32. ★ Rehydration and maintenance ORS ★ Continued breastfeeding and refeeding with with an age-appropriate, unrestricted diet as soon as dehydration is corrected ★ Micronutrient supplementation ○ Zinc supplement ○ Probiotics ★ Antimicrobial therapy – if indicated Management
- 34. ★ Exclusive Breastfeeding until 6 months of life ★ Vit A supplement ★ Rotavirus Immunization ★ Improvement of hygiene, sanitation and water supply Prevention
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Hinweis der Redaktion
- Case of: Acute Gastroenteritis with Moderate Signs of Dehydration
- HPI: 4 days prior to admission, patient noted 2x episodes vomiting with the ingested milk, associated with 1x episode of loose bowel movement, no intervention done. 3 days prior to admission, recurrence of vomiting up to 2x of previously ingested food associated with 2 episodes of loose bowel movement with a characteristic of yellow watery stool. The parents took the child to the ER for consult and was subsequently sent home with take home medications including ORS, zinc sulfate drops and erceflora.
- In the interim, patient noted to have 5 episodes of loose bowel movements per day of mushy light green, non mucoid, non-bloody. Few hours prior to admission, patient had again loose bowel movements for 4 times. She was noted to be weak looking, irritable, accompanied by incessant crying which prompted consult again at the ER hence confinement
- For growth and development history, patient is expected to do and achieve the following milestone appropriate for her age. We take note that the patients age is 1 year and 4 months which would fall under 15 months At 15 mos she is expected to
- -most commonly caused results of infections with bacterial, viral or parasitic pathogens -many these are foodborne illnesses
- Most common bacterial pathogens are Salmonella, Shigella, Campylobacter and yersinia 5 pathotypes of E. coli, 2 serogroups of Vibrio cholerae foodborne illness due to their ability to produce emetic and/or enterotoxins include Bacillus cereus, Clostridium perfringens, and Staphylococcus aureus.
- Important to note in the history are Duration of diarrhea and a description of stools (frequency, amount, presence of blood or mucus) vomiting (onset, amount and frequency) fever (duration, magnitude), vomiting (onset, amount and frequency), and the amount and type of solid and liquid oral intake Clinical signs of dehydration should be evaluated urine output (number of wet diapers per day and time since the last urination), whether eyes appear sunken, whether the child is active, whether the child drinks vigorously
- Stool CS- are indicated in severe cases like shigella and salmonella ABG - metabolic acidosis BUN, Crea - poor UO
- Weak looking, normal skin turgor, CRT <2sec, slightly sunken eyeballs, dry lips, hyperactive bowel sound