DIARRHEA OF 1 DAY

DURATION
Durante, Esperon, Espino, Fernando,
Figuracion, Flores, Fong, Francisco
J.
Identifying Data

 5 month old
 Male
 Admitted for the first time
Chief Complaint

 Diarrhea of 1 day duration

History of Present Illness

 Diarrhea
 watery in consistency, yellow and
color and non-foul smelling
 It is non-bloody and non-mucoid
 Episodes of diarrhea was
approximated to be at least one
episode in ten minutes
 associated with irritability &
decreased in activity
History of Present Illness

 sunken eyeballs
 depressed anterior fontanelle
 and increased water hunger
 patient had an undocumented fever
few hours PTA
History of Present Illness

 no vomiting and skin changes

 Urine output and last urine output
cannot be ascertained
 The patient was not introduced to
a new diet.
Prenatal History
 The mother had hyperglycemia at 6
months
 She had UTI at first trimester and
was prescribed with Cefalexin for
1 week
 She had cough and cold at first
trimester and was prescribed with
unrecalled antibiotic
Birth History
 born full-term
 via normal spontaneous vaginal
delivery at a hospital, physician-
assisted
 Birth weight = 2360g
 Birth Length = 46cm
 had a lump on his head that was
non-progressive and went away
before 1 month of age
Neonatal History
 had cough and cold that presented
as runny nose
 prescribed with carbocysteine and
an unrecalled medication
 Medication were taken with good
compliance
 no history of jaundice, pallor,
convulsions, hemorrhage or dyspnea
Feeding History
 The patient was not breastfed.
 No history of milk allergy
 No solid food was given to the
patient
 From birth to 2 months
 S26 with a dilution of 2:1given every 3
hours.
 From 2 months to present
 BONA with a dilution of 2:1given every
5 hours
Immunization History
 BCG vaccine at 1 month of age
 3 doses of DPT at 3 months, 4
months, and 5 months of age
 3 doses of OPV at 3, 4, 5 months
of age
 2 doses of Hepatitis B vaccine at
birth and 3 months of age and
 Measles vaccine
Developmental History
 1 month: responds to sounds; stares at
faces
 2 months: vocalizes; follows objects
 3 months: laughs; holds head up
steadily; squeals, coos, recognizes
voice
 4 months: can grasp toys; roll over; can
bear weight on legs
 5 months: recognizes own name; turns
towards sounds; play with hands and feet
Past Health History
 no prior history of illness
Social and
Environmental History
 lives in an apartment with 2
bedrooms and 1 toilet and bath
together with 3 other occupants
 garbage is collected every day
 Water for utility purposes is from
Maynilad and drinking water form
from a distilling station
Physical Examination
 Vital Signs
 Pulse: 140 bpm
 Respiratory Rate: 35 breaths/min
 Temperature: 36.9° C axillary
Physical Examination
 Anthropometric Measurements
 Height/Length:
 Weight:
 Head Circumference:
 Chest Circumference:
 Abdominal Circumference:
 Wasting:
 Stunting:
Physical Examination
 Skin
 No lesions were noted
 Smooth and warm
 has normal turgor
 
Physical Examination
 HEENT
 anterior fontanel open and not
depressed; posterior closed;
symmetric
 anicteric sclerae, pinkish palpebral
conjunctivae, eyeballs are not sunken
 oral mucosa is pink, moist and smooth
 all lymph nodes are normal and
nontender.
Physical Examination
 Chest
 Good and equal chest expansion.
 Audible breath sounds.
 No rhonchi, rales or wheezes noted
 Cardiovascular
 adynamic precordium
 good and distinct S1 and S2,
 no murmurs or extra heart sounds
Physical Examination
 Abdomen
 Abdomen was protuberant but soft
 normoactive bowel sounds
 all 4 quadrants are tympanitic
 no tenderness and mass noted on light
and deep palpation
 liver edge is 1cm below the right
costal margin
 spleen and kidneys palpable.
Physical Examination
 Genitalia
 Tanner stage 1
 Normal scrotum on both sides, testes
descended.
 Musculoskeletal
 no deformities
 Negative Ortolani and Barlow tests
Neurologic Examination
 Mental status
 the patient is awake, has regard to
people around him and responsive to
any kind of stimuli
 Motor tone
 no flaccidity and/or spasticity
 Sensory function
 positive withdrawal to painful
stimuli
Neurologic Examination
 Cranial nerves
 I – cannot be assessed
 II - acknowledged presence with facial
expression and tracking
 II, III - (+) optic blink reflex, (+)
papillary response
 III, IV, VI - (+) tracking, all directions
 V - effectively sucks milk from bottle
 VIII - simultaneous blink upon hearing loud
clap
Neurologic Examination
 IX and X - good coordination during
swallowing and sucking
 XI - symmetrical shoulders
 XII - tongue midline
Neurologic Examination
 Deep tendon reflexes
 +2 on ankle, knee and elbow
 Primitive Reflexes
 Negative: Moro reflex, rooting reflex
 Positive: support reflex,
placing/stepping reflex, Parachute
reflex, Palmar grasp, Plantar grasp,
Babinski
Subjective
 5-month old
 diarrhea of 1 day duration
 yellow in color, non- foul smelling,
non-bloody and non-mucoid
 irritability, decrease in activity,
 sunken eyeballs;
 depressed anterior fontanelle;
 increased water hunger. the urine
in the diaper.
Subjective
 had undocumented fever the next
day
 no vomiting and no new food
introduced
Objective
 Unremarkable PE
 PE done on the 4th hospital day
Primary Impression:
ETEC Diarrhea
 PRIMARILY CONSIDERED DUE TO:
 age of incidence
 symptoms the patient manifested
 watery diarrhea and fever
Primary Impression:
ETEC Diarrhea
Differential Diagnosis:
Typhoid Fever
Differential Diagnosis:
Giardiasis
Differential Diagnosis:
Rotavirus
Gastroenteritis
Differential Diagnosis:
Vibrio Cholera
Gastroenteritis
Plan
 Assessment of the fluid status

Symptom Mild to moderate

(3-9% loss of body wt)
Mental status Normal,
fatigued or
restless;
irritable
Thirst Thirsty; eager
to drink
Eyes Slightly sunken
Plan
 Give ORS; 75 cc/kg in 4 hours
 If at the 4th hour, the patient is well
discontinue ORS and give sugar/salt
solution 50-100 cc for every bowel movement
 If however the patient deteriorates proceed
with intravenous therapy, 75 cc/kg in 4
hours LRS (lactated ringer solution)
 If reassessment shows severe dehydration
(>10% weight loss) we should give 30 cc/kg
in 1 hour and 70 cc/kg in the next 5 hours
Plan
 If ETEC is suspected bacterial
culture should be done from
samples of stool
 Antibiotics can shorten the
duration but usually not required
 Fluoroquinolones have been shown to
be effective therapy