CLINICAL CASE PRESENTATION

-GROUP 1C(PEDIATRICS)
 •Alphya Kuttikatt Shaju
•Divya Krishnan
•Jasmin Haritha Krishnan Moodachiyil
Radhakrishnan(leader)
•Kaviyarasan Kumarasamy
•Mahesh Marri
GROUP MEMBERS •Neeraja Koonaka
•Pattaracha Khingthong
•Poulami Mandal
•Sandeep Kokkiligadda
•Ula Elfatih Ali Mohamed
•VivekKumarJanakbhai Mangukiya
•Nara Niranjan
G E N E R A L D ATA

Name : Pookie Orsal Jr.

Age: 3 YO
Gender- Male
Religion-Roman Catholic
Nationality Filipino
Address - Pardo, Cebu city
Hospital - Gullas memorial Hospital
Informant – father

CHIEF COMPLAINT

Diarrhea
 HISTORY OF PRESENT ILLNESS

5-days PTC, patient had watery diarrhea and vomiting

episodes of 3-5 times/ day.Reported non bloody/ non mucoid/
non foul smelling vomitus.
Volume ranges around 1 cup per episode diarrhea,1 and half
cup vomitus.Oresol was given but patient refused to have
it.He had fever for 3 days and tempra 40 ( 250 mg/5 ml) was
given.Fever kept on recurring even after taking medication.
PRENATAL HISTORY

1st child, No abortion/miscarriage. Regular prenatal check up

with an OB-GYNE. No disease/ infections/drug uses reported.
Regular intake of nutritious food and multivitamins.
Got TT vaccine at 7 and 8 months.
U/S at 8 months, No X-ray or radiation exposure of any kind.
NATAL HISTORY

Normal spontaneous vaginal delivery at chong hua

hospital by OB specialist, full term 40 weeks.
labor duration for 10 hours and membrane rupture time 6
hours from delivery.
No use of drug( sedatives/analgesics)during labor.
No birth injuries or post complications.
APGAR score 9,10 , good cry ,no tachypnea
POSTNATAL HISTORY

Immunization data
BCG and Hep B ✓
Complete 3 doses of Polio, DPT,HIV type
B ,pnuemococcal conjugate vaccine✓
Measles vaccine at 9 months and MMR at 1 year
Breast fed upto 2 years old, Solid food introduced at 6
months, Good appetite
Good development. No development delays
No weight information before get sick
Weight 15 kg,Height 95 cm
 PAST MEDICAL HISTORY

No previous hospitalisation
History of cough at 2 years old.Salbutamol given .

FA M I LY H I S T O R Y

No hereditofamilial disorders,no diabetes, no hypertension,

no congenital anomalies, no TB, no leprosy.
 SOCIAL HISTORY

Mother, 25 years old working as call center agent

Father, 37 yo engineer

Live at their own house at subdivision. (4 people live in the house;

father, mother, child and helper). No pet

Good economic status( Father income 50k per month mother 30k
per month).Water supply from MCWD got interrupted by Dec 18
onwards due to typhoon Odette but fire trucks and government
aids providing free water supply at intervals.Electricity(from
VECO) accessibility is also blocked.

No History of travel since beginning of pandemic

 P H Y S I C A L E X A M I N AT I O N

Irritable, refused to drink oresol, in acute respiratory

distress,
Temp 38.9 RR 25 breaths per min
HR 140 bpm BP not taken
O2 saturation 95%

SKIN: poor turgor,

HEENT: dry lips, sunken eyeballs, no
tonsillopharyngeal, no lesions, no discharge in
ears ,Neck supple.

RESPIRATORY: Equal chest expansions and clear

breath sounds
CVS: Tachycardic, regular rhythm, no murmur
ABDOMEN: globular, hypoactive bowel sounds, tympanitic
GUT: grossly male, scanty urine
EXTREMITIES : slightly cold, CRT 2 seconds
CNS: normal

Lab reports
Na 138 k 3
ABG PH of 7.3, paco2 40, hco3 16
Stool exam negative, no pus, RBC, parasite-negative stool exam
 ANTHROPOMETRIC
MEASUREMENTS

INFERENCE

This boy is normal weight

for the age
 INFERENCE

Normal height for the age

INFERENCE

normal for weight for

length/height
 INFERENCE

Normal BMI for age

 INITIAL DIAGNOSIS

ACUTE GASTROENTERITIS with

Moderate dehydration , Hypokalemia
and Metabolic acidosis
common illness in infants and young children.
Viruses cause most gastroenteritis - MAIN
ETIOLOGY
DIFFERENTIAL
DIAGNOSIS
PAT H O G E N E S I S
 ✓ Watery, usually nonbloody diarrhea

✓Nausea, vomiting or both

CLINICAL
✓Stomach cramps and pain
MANIFESTATIONS
✓Occasionally muscle aches or headache

✓Low grade fever

 Diagnosis based on clinical
recognition, evaluating severity by
rapid assessment.
DIAGNOSTIC
WORK UP
For most cases,no lab tests are
required except for epidemiologic
purposes.
STOOL EXAM Examine for mucus,blood, leukocytes
✓Fecal leukocytes indicate bacterial
invasion of colonic mucosa
✓early infection by Shigella,Shiga
toxin producing E-coli,or E - histolytica

STOOL CULTURE Usually done in the following cases

✓Suspected invasive bacterial

enteritis, severe illness, or fever (>
38.5 degrees), required
hospitalization, or stool tests
positive for leukocytes/occult
blood/lactoferrin.
 T R E AT M E N T & M A N A G E M E N T

Primary concern ?
> Treat dehydration

1.Oral rehydration -
If weight <10 kg ,60–120 mL of an oral rehydration solution
(ORS) per episode of vomiting or diarrheal stool , If weight >10
kg,120–240 mL of ORS per episode of vomiting or diarrheal stool
in addition to their normal daily requirements.

Here the patient is 15 kg and has 3-5 times of diarrhea and 1

episode of vomiting. So we should add at least 360 – 720 ml of
ORS in daily basis.
2.IV fluid therapy

In case of mild to moderate dehydration

For children with severe dehydration, Ringer’s lactate or
normal saline (20 mL/kg) should be given intravenously
over 1 hour.
Secondary concerns?

Early refeeding with age appropriate diet

Benefits -
1. Increase digestive enzymes action
2. improve nutrient absorption
3. Decreasing intestine permeability changes caused by
infections

Antidiarrheal & Antiemetic medications

-Ondanestron 2mg initial dose
CASE SUMMARY

A 3 year old male child was presented with diarrhea 5 days PTC and vomiting episodes
of 3-5 times with no blood or mucus .He also had fever for 3 days . Paracetamol given
but fever recurred again.. He is the first child, delivered vaginally at Chong Hua
Hospital by OB specialist at full term 40 weeks.APGAR scoring was9-10. Breast fed
upto 2 years old .There is no hereditofamilial disorders.

Due to typhoon they faced unavailability of water and electricity .There is no history of
travel .Patient refused to drink oresol in acute respiratory distress.It was also noted
he's having dry lips and sunken eyeballs,tachycardia present,hypoactive bowel sounds
in abdomen.

Considering the clinical manifestations, the most possible diagnosis is “ Acute

Gastroenteritis”.Stool exam and stool culture can use for further
evaluation .oral rehydration and IV fluid therapy can use as the primary
management and also appropriate diet can help. Antidiarrheal and antiemetic
medications are also considered.
THANK YOU