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Pediatric Hand Foot and Mouth Disease With Acute Gastroenteritis
Pediatric Hand Foot and Mouth Disease With Acute Gastroenteritis
Pediatric Hand Foot and Mouth Disease With Acute Gastroenteritis
CONFERENCE
CLINICAL HISTORY
Informant: Mother
Reliability: 65%
General Data
● AV
● 1 year and 2 months
● Born on December 15, 2015
● Admitted for the 1st time at our institution on February 27,
2017
CHIEF COMPLAINT
Anthropometric measurements
Weight: 7.2 kg
Head circumference: 46 cm
Chest circumference: 47 cm
Abdominal circumference: 44 cm
Wt: 7.2 kg
Age: 1 yr 2 mos
Length: 70 cm
Age: 1 yr 2 mos
Weight: 7.2 kg
Length: 70 cm
HC: 46 cm
Age: 1 yr 2 mos
Physical Examination
HEENT: sunken eyeballs, pink palpebral conjunctivae, white sclerae, patent ear canals,
patent nostrils, dry lips, moist buccal mucosa, hyperemic pharyngeal wall with multiple
ulcers with erythematous base on posterior pharyngeal wall
NECK: supple neck, no palpable cervical lymph nodes
LUNGS: symmetrical chest expansion, no retractions, clear breath sound, good air entry
HEART: adynamic precordium, normal rate, regular rhythm, no murmurs
Physical Examination
ABDOMEN: slightly globular, soft, normoactive bowel sounds, no tenderness, no
palpable masses, no lesions
EXTREMITIES: no gross deformities, full and equal pulses, with CRT <2 seconds
SKIN: erythematous perianal rash, maculopapular rash with erythematous base on
feet, legs, thighs, abdomen
Neurologic Examination
Cerebrum: Awake and fretful
Cerebellum: no nystagmus, no ataxia
Cranial nerves:
I: N/A
II: 2-3 mm pupils equally reactive to light
III, IV, VI: Intact extraocular muscles
V: Good sucking, can clench teeth
VII: No facial asymmetry
VIII: Intact gross hearing
Neurologic Examination
IX and X: Can swallow meals
XI: Can turn head from side to side
XII: Tongue at midline
Motor Function: Can move all extremities
Sensory Function: Withdraws to pain
Deep Tendon reflex: +2
Reflexes: No primitive reflexes, (-) Babinski sign
Signs of Meningeal Reflexes: No nuchal rigidity, no Kernig sign, no Brudzinski sign
Salient Features
● 1 year and 2 months
● CC: Decreased appetite for 6 days
● Intermittent fever Tmax: 39 C (5 days PTA)
● Decreased activity
● Non-projectile vomiting of previously ingested milk
● Watery based bowel movements (bristol type 7) sour smelling, non frothy
Salient Features
● Moderate dehydration, tachycardic, tachypneic
● Sunken eyeballs, dry lips
● Hyperemic pharyngeal walls with multiple ulcers with erythematous base on
posterior pharyngeal walls
● Erythematous perianal rash
● Maculopapular rash with erythematous base on feet, legs, thighs, abdomen
INITIAL IMPRESSION
Hand, Foot, & Mouth disease;
Acute gastroenteritis, probably viral;
Moderate dehydration;
t/c Lactose intolerance, secondary;
Diaper rash, secondary;
t/c Urinary tract infection;
Primary Pulmonary Tuberculosis
=
Differential Diagnosis
● Decreased appetite
K+ 3.94 3.3-4.6
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