Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat Gastroenteritis and

Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat

Gastroenteritis and dehydration


Case 1: 11 months old boy

• 2 day history of vomiting and diarrhea• Older brother in daycare same symptoms last week• last urine output this morning (now: 4pm)• 4 diarrheas today, vomited 2 times• parents can’t get her to drink. The two times she

accepted fluid, she threw up


Examination

• Uncomfortable, gives contact, no smile• T 38,4• HR 135• skin turgor slightly reduced• capillary refill time 2sec• mucus membranes wet


Lab

• CRP 8

• Diagnosis?• Admit to hospital?• Other solutions?


Viral gastroenteritis


History

• Ensure correct diagnosis! (fever, gastroenteritis in the family/community, both vomiting and diarrea?)

• Duration• Amount of ongoing losses• Ability to maintain an adequate intake• Urine output• Weight loss

– <5% mild

– 5-10% moderate

– >10% severe


Clinical examination

• Capillary refill time• Skin turgor• Respiratory rate• Pulse• Sunken fontanel• Dry mucus membrane• (blood pressure)


Laboratory investigations

• bicarbonate level (<15-17)– OBS: profuse vomiting leads to metabolic alkalosis

• urea• (Na, K, pH, Base Excess, kreatinin, Hb, WBC)


Treatment

• Oral rehydration– Commercial solutions

– Small amounts often with teaspoon/syringe

• Nasogastric tube– Continous supplement

• Intravenous – NaCl 20ml/kg


Case 2: 3 months old girl

• 1 day history of vomiting (x1) and diarrhoea• 3 stools/hour for the last 3 hours. Two large watery

diarrhoeas while in your office• Accepts some fluid without throwing up, but much

less intake than usually• Urine output unknown, all dipers are wet of

diarrhoea.• Slept much more than usual


Examination

• Smiles, excellent contact. Acitvity looks fine• HR 145, RF 50• Capillary refill time 2 sec• Mucus membranes wet• Turgor OK

• Admit to hospital?


Case 3: 1,5 years old

• Smiles, excellent contact. Acitvity looks fine• HR 145, RF 50• Capillary refill time 2 sec• Mucus membranes wet• Turgor OK


Examination

• Uncomfortable, difficult to calm, keep crying• T 40• HR 150• Skin turgor ok. • Capillary refill time 3 sec. • Distended abdomen, painful. Some bowel sounds

presents

• Admit to hospital?

Documents

Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat Gastroenteritis and