Skip to main content
WardSpace
Pediatric cases

Thirsty for weeks, vomiting since this morning

A 12-year-old has been drinking litres, wetting the bed again, and losing weight. Today he cannot keep water down and is breathing strangely.

Age12 yearsWeight38.0 kg

Pediatrics

12 years old· adolescent38.0 kgboy, Pediatric emergency, resuscitation bayFictitious educational patient
Caregiver
Mother: 'For about three weeks he has been drinking constantly and getting up at night to pee. He wet the bed twice, which he has not done since he was four. His trousers are loose. Since this morning he has vomited five times and now he is breathing like he has been running.'
Feeding
Eating less for a week; nothing kept down today.
Intake and output
Polyuria for three weeks; vomited five times today.
Immunizations
Up to date.
Previously well

Day 0 · 11:05

Arrival

He walks in leaning on his mother, pale, with deep sighing respirations and a sweet smell on his breath. He answers questions slowly but correctly.

Vitals

HR128high for ageBP104/66RR32high for ageSpO299%T36.7

Read against the adolescent band (12 to 17 years): HR 60 to 100 awake, RR 12 to 20, hypotension below 90 systolic at the youngest age in the band. Fever, crying and pain move these numbers.

Before any result returns, what is the working diagnosis and the first bedside test?

Answer the question above to continue.