PAEDIATRIC GASTROENTERITIS CASE STUDIES

THE CASE STUDIES WILL BE DISCUSSED THROUGHOUT THE BROADCAST. WORK THROUGH THE CASE STUDIES WITH THE PANEL MEMBERS REMEMBER YOUR CLINICAL TREATMENT DECIONS SHOULD BE MADE IN THE CONTEXT OF YOUR OWN WORK ENVIRONMENT AND CLINICAL POLICIES.

CASE STUDY 1 BEN

Ben is 6 months old and presents to your busy clinic accompanied by his father. His father describes Ben as being unwell throughout the day with a history of intermittent vomiting. He thinks that he might have some pain as he has been crying and drawing up his legs. Ben is the first child in the family and Dad is very concerned. What are your first impressions describe your hands off assessment at this point? What potential differential diagnosis could you be thinking of at this time? There are 6 other children also waiting in your clinic based on the fathers story, what triage category / priority would you assign to Ben? Physical examination and history reveal the following: History: Full term breast fed baby, immunisations up to date, no illnesses or health problems to date. O/E: pale, slightly lethargic infant Temp 38, HR 160, RR 35, BP: difficult to obtain, SaO2 98% CR > 2sec Weight, 6.5 kg Urine Output: 2 wet nappies in the last 24hrs, no diarrhoea Abdomen: no masses palpable, examination appears to aggravate the baby Does your examination alter your initial impression or priority assigned to Ben? What would your course of management be for Ben? Include any interventions, investigations, consultation.

CASE STUDY 2 VANESSA

1600hrs Vanessa is 13 yrs of age and presents to you accompanied by her mother with a 2 day history of vomiting and some diarrhoea and low grade fever. She has been previously well. There are 2 other children in the family; no other family members are unwell. Vanessa is mildly lethargic and when you talk with her she indicates she prefers her mother to answer your queries What are your first impressions describe your assessment at this point. What potential differential diagnosis could you be thinking of at this time? Your history and examination yield the following information History Previously well child, Menstruating started using tampons 2 months ago. LMP: currently menstruating. Denies sexual activity. Current illness started 2 days ago with progressive nausea, diarrhoea started yesterday O/E Pale, slightly lethargic, dry lips. Temp 38, RR 22, HR 110, BP 80/56 Sao2 98% CR 2 secs Weight 26kg Urine output has voided x 2 since yesterday afternoon Abdominal examination: mildly tender, no masses palpable Action: You choose to insert an IV cannula and after drawing some blood for pathology (FBC, Hct, Serum Osmol, UEC, BGL), commence a litre of fluid. Calculate Vanessas percentage of dehydration. What is your fluid choice? What rate would you start at? 1730 HRS Observations: HR 125 BP 75/48 RR 22, CR 2secs SaO2 98% Urine output 30 ml since arrival: UA: SG 1015, -ve protein, -ve blood Blood results show a raised white cell count, Hct 0.40, Na 138mmol/l, K 4 mmol/l Creatinine: 106mol/L,

Do these results and Vanessas response to the IV fluid you have prescribed alter your plan of action and potential diagnosis? Describe your ongoing course of management for Vanessa. Include any interventions, investigations, consultation.

CASE STUDY 3 GEORGE

George presents with his mum to your clinic. He has been unwell for 24 hours with vomiting and diarrhoea and a fever. Mum states that the vomiting and diarrhoea has been frequent, and with two older siblings also unwell, she has lost track of how many times George has vomited or had diarrhoea throughout the day. He is now becoming increasingly unwell; mum is extremely worried about him. Your across the room assessment is of a very pale, disinterested child. On examination George is pale and floppy and has no interest in you or his environment. HR 95, RR 30, BP unable to obtain. C R 3 seconds Temp 38.5C

What are your initial actions and assessment? You attempt to insert gain IV access.

You are unable to gain IV access. How long should you pursue this attempt what access choices do you have? What is your choice of fluid why? Calculate Georges fluid replacement and maintenance requirements. Calculate the percentage of dehydration. What are the potential differential diagnosis could you be thinking of at this time? What is your ongoing your course of management for George? Include any interventions, investigations, consultation.