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Pediatric cases

Vomiting and diarrhea, and only two wet diapers

An 18-month-old has had two days of vomiting and watery stools. Her father counts diapers, and today's count is two.

Age18 monthsWeight10.2 kg

Pediatrics

18 months old· toddler10.2 kggirl, Pediatric emergency, room 6Fictitious educational patient
Caregiver
Father: 'It started Tuesday night with vomiting, then the diarrhea, maybe eight watery stools a day. She keeps asking for her cup and then brings it back up. Two wet diapers today and they were small. She weighed 11 kilos at her check last month.'
Feeding
Drinking eagerly but vomiting most of it; refusing solids.
Intake and output
Two small wet diapers today; eight watery stools; vomiting after most drinks.
Immunizations
Up to date, including rotavirus.
Previously well

Day 2 · 15:10

How dry is she?

She is on her father's lap, whimpering, reaching for a cup. Weight today 10.2 kg.

Vitals

HR148high for ageBP90/56RR32SpO298%T37.9

Read against the toddler band (1 to 3 years): HR 98 to 140 awake, RR 22 to 37, hypotension below 72 systolic at the youngest age in the band. Fever, crying and pain move these numbers.

Examination

  • Appearance: Irritable but consolable; alert; makes eye contact.
  • Hydration: Dry lips and tongue, few tears, eyes mildly sunken, capillary refill 2 to 3 seconds, skin pinch returns slowly, hands warm.
  • Abdomen: Soft, non-distended, mildly tender diffusely, no mass; active bowel sounds.

Grade the dehydration, using the weight.

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