PEDIATRICS CASE

PRESENTATION
- C DIVYA
CASESHEET
 NAME : Ananya
 AGE : 4 years
 GENDER : Female
 ADDRESS : Porur
 INFORMANT : Mother
 RELIABILITY : Good

CHIEF PRESENTING COMPLAINTS :

Loose stools and vomiting for the past 2 days.
HISTORY OF PRESENTING ILLNESS

The baby was apparently normal 2 days back, after which she
developed loose stools which was sudden in onset, 4 -6 episodes/day,
watery in consistency, foul- smelling, no blood/mucus/worms.
No precipitating or relieving factors
No H/o drug intake
No H/o pain during defecation
Vomiting for the past 2 days, 4-5 episodes/ day, after intake of
food. Vomitus contained undigested food particles.
It was non -projectile, non- bilious, not blood stained.
No H/o abdominal pain , abdominal distension
No H/o Fever
No H/o decreased urine output
No H/o convulsions
H/o excessive thirst
H/o recent travel
PAST HISTORY

No similar episodes in the past

No H/o radiation
No H/o drug intake
No H/o allergy
No H/o TB, asthma, jaundice, measles
ANTENATAL HISTORY
1st born child out of a non- consanguineous marriage
Mother had a spontaneous conception.
She was registered and immunised
All 3 trimesters were uneventful.
BIRTH HISTORY
It was term, institutional, normal vaginal delivery
The baby cried immediately after birth, breastfed after 1 hr.
Birth weight - 3 kg
No NICU admission
NEONATAL HISTORY
Breast feeding initiated after 1hr of delivery
Exclusively breastfed upto 6 months of age.
No NICU admission

DEVELOPMENTAL HISTORY
No delay in milestones
IMMUNISATION HISTORY
Fully immunised till date as per National Immunisation
Schedule.

FAMILY HISTORY
No similar complaints in the family.

SOCIOECONOMIC HISTORY
Lower middle class according to Modified Kuppuswamy
scale.
SUMMARY
A 4 year old girl child, normal term delivery, belonging to
lower middle class as per modified kuppuswamy scale,
achieved all developmental milestones upto age, fully
immunised, giving H/o of travel, H/o excessive thirst has
presented with diarrhoea and vomiting for the past 2 days.
GENERAL EXAMINATION
Consent was obtained and the child examined.
Child appears restless
No pallor, no icterus, cyanosis,clubbing, pedal edema, generalised lymphadenopathy
Eyes-sunken, tears - absent
Mouth & tongue - dry
VITAL SIGNS
RR- 30 breaths/min
Pulse rate - 90 beats/min, regular in rhythm, character and volume with no radio
radial or radio femoral delay.
BP: 90/60 mmHg, measured in right brachial artery in sitting position.
Temperature: Afebrile
ANTHROPOMETRY
Weight – 11 kg
Height – 93 cm
Ht for age < - 2 SD , stunted
Wt for age <- 2 SD , Underweight
Wt for height <- 2 SD , Moderate acute malnutrition
 HEAD TO FOOT EXAMINATION
 Head size and shape normal
 Face – normal
 Ears,nose – Normal
 Eyes – appear sunken and dry
 Oral cavity lips and mouth – appear dry
 Neck – normal
 Skin turgor – goes back in 2 sec
 Chest, spine, palms,limbs - normal
 External genitalia - normal
SYSTEMIC EXAMINATION
ABDOMINAL EXAMINATION
INSPECTION
Not distended, all quadrants move equally with respiration
Flanks are free
Hernial orifices normal
Umbilicus normal in midline
No engorged veins,scars,sinuses
PALPATION
Not warm, soft, no tenderness
No palpable spleen, liver or other palpable masses
PERCUSSION - Liver span normal
AUSCULTATION - Bowel sounds are heard
OTHER SYSTEMS

RESPIRATORY SYSTEM
Normal vesicular breath sounds heard

CARDIOVASCULAR SYSTEM
S1 and S2 sounds heard, no murmurs

CENTRAL NERVOUS SYSTEM

No focal neurologic deficit
SUMMARY
A 4 year old girl child, normal term delivery, belonging to
lower middle class as per modified kuppuswamy scale,
achieved all developmental milestones upto age, fully
immunised, giving H/o of travel, H/o excessive thirst has
presented with diarrhoea and vomiting for the past 2 days.
O/ E she was moderately malnourished , with signs of some
dehydration.
PROVISIONAL DIAGNOSIS
Case of acute gastroenteritis probably of viral etiology, with
signs of mild dehydration.
MANAGEMENT
INVESTIGATIONS
 Stool examination
Macroscopic - colour, consistency, presence of mucous or blood.
Microscopic - pus cell/ leukocyte count( > 10 cells /HPF) , Ova, Cysts,
Trophozoites, Leucocytes
Hanging drop for V. cholerae
 Blood tests - CBC, PBF
Serum Electrolytes
BUN and Creatinine
Culture and sensitivity
 Urine - R/M, Culture may be required
TREATMENT
 Treatment of Dehydration - Plan B treatment of diarrhoea with some dehydration
WHO :
Low osmolarity ORS given - 75 ml/kg over 4 hrs, reassesed after 4 hrs.
10- 20 ml/kg- ongoing losses
 Dietary management- continue regular feeding with energy dense foods with least
bulk. Eg- Rice, khichri, pulses,curd,yogurt,etc.enriched with fats,oil,sugar.
 Recommended fluids-lemon water, rice water, soups,dal water ,coconut water,etc.
 Foods to be avoided- fruit juices, junk foods, spicy foods,carbonated drinks, tea,
coffee.
 Zinc therapy - 10mg/day in < 6 months , 20 mg/day in > 6 months for 2 weeks.
 Antimicrobials - Antibiotics have no role in acute diarrhoea since its mostly viral
etiology.
PREVENTION
 Improvement of Nutritional status.
 Safe drinking Water Supply & improved sanitary facilities in the community,
good hygiene.
 Exclusive Breast feeding till 6 Months.
 Easy availability of ORS sachets.
 Health education - Hand washing before handling food, early signs &
symptoms of diarrhoea, details about proper use of ORS.
 Vaccines :
Rotavirus vaccine
Cholera Vaccine
Typhoid Vaccine
ETEC Vaccine
THANK YOU!!