PEDIA II WARD
Banatao, Lenard Mien C. Presented to:
Bancud, Maria Angelica C. Dr. Ma. Consuelo Manuel
Section D1 – Group 3
Date of Interview: August 7, 2019
Time of Interview: 5:20 PM
Informants: The patient’s Grandparents
Reliability: 90%
General Data:
Name: F.B.
Age: 6 Months Old
Gender: Female
Date of Birth: January 28, 2019
Address: Mallig, Isabela
Nationality: Filipino
Religion: Roman Catholic
Date of Admission: August 6, 2019
Time of Admission: 5 PM
Chief Complaints:
Diarrhea
History of Present Illness:
4 days PTA, the patient had 4 episodes of loose bowel movement of watery consistency,
non-mucoidal and non-bloody with no other associated signs and symptoms. No consultation
was done and no medications given.
3 days PTA, patient still noted with the above signs and symptoms was brought to
Manuel A. Roxas District Hospital and was admitted. Given IV Ceftriaxone. During the course of
admission, patient started to have fever, vomiting and difficulty of breathing. Unrecalled
medications were given.
Few hours prior to admission, symptoms still persisted so the patient was referred to
CVMC.
Past Medical History:
Patient had no previous hospitalizations, surgeries or significant illnesses. She has no
allergic reactions to milk and medications.
Prenatal History:
The patient’s mother had prenatal check-ups throughout pregnancy. She had
multivitamins and ferrous sulphate. She did not smoke, drink, or use recreational drugs, and
didn’t have any exposure to radiation and any infectious diseases during the pregnancy.
Birth History:
Born to a 16yr old G1P1 (1001) mother, delivered via NSD at Manuel A. Roxas District
Hospital with a birth weight of 2.1 Kgs.
Neonatal History:
F.B. had good suck and good cry, with bowel movements.
Nutritional History:
The patient was breastfed for 1 week and was shifted to formula milk.
Immunization History:
1 dose of BCG and Hepa B vaccines were given at birth
2 doses of Pentavalent Vaccine were given at 6th and 10th week
2 doses of OPV given at 6th and 10th week
Family History:
The patient’s mother is alive and well, has history of asthma, no family history of
hypertension, diabetes, heart disease, cancer, allergies, PTB. The patient’s father is alive and
well, without any familial diseases.
Personal and Social History:
Patient F.B. was born in Isabela and is the first child of the couple. Her father, 18 years
old is a butcher and her mother, 16 years old and a student. They live together with her
maternal grandparents.
REVIEW OF SYSTEMS
Constitutional: (+) Fever
Skin: (+) Dry Skin, No Lumps, No Itching
Eyes, Ears, Nose, Mouth/Throat: (-) Redness, (-) Otorrhea, (-) Epistaxis, (-) Bleeding Gums
Respiratory: (+) Difficulty of Breathing
Cardiovascular: No Syncope, No Cyanosis
GI: (+) Vomiting, (+) Abdominal Pain, (+) Loss of Appetite, No blood in the stool
Renal: No Dysuria, No Hematuria
Musculoskeletal: No Myalgias or Arthralgias
CNS: (-) Seizure, (-) Syncope
Hematologic: No Pallor, No Bleeding
PHYSICAL EXAMINATION:
General Appearance:
The patient is unconscious, and lying on bed with ongoing IVF of D5 0.3 NaCl 1L hooked
at L hand, patent and infusing well, with endotracheal tube attached to mechanical ventilator.
Anthropometric Measurements:
Head Circumference:
Chest Circumference:
Abdominal Circumference:
Height: 56 cm
Weight: 5 Kg
Vital Signs:
Temperature: 38.5o C (Axilla), Febrile
Heart Rate: 137 bpm, Regular
Respiratory Rate: 62 cpm, Regular, Tachypneic
Skin: (-) Jaundice, (-) Pallor, Poor skin turgor
Head: Normocephalic, Hair is black and thin, Depressed Fontanel
Eyes: Sunken Eyeballs, Symmetrical, No discharges noted
Ears: Symmetrical, No swelling, (-) Discharge
Nose: No discharge
Mouth: Dry Lips, Dry Mucosa
Neck: (-) Cervical lymphadenopathy, Trachea midline
Thorax and Lungs: Symmetrical Chest Expansion, (-) Retractions, (+) Crackles, (-) Wheezing,
Heart: PMI at the 4th ICS left mid-clavicular line, Adynamic precordium, No murmurs
Abdomen: Globular. Bowel sounds are present.
Extremities: No gross deformities, Warm to touch, No edema
Salient Features:
Patient is 6-months old with fever, diarrhea, abdominal pain
Diagnosis:
Severe AGE
Differential Diagnosis:
1. Amoebiasis
RULE IN RULE OUT
Fever Bloody Diarrhea
Watery Diarrhea Incubation Period of 2-4 weeks
Abdominal Pain Foul Smelling Stool
Loss of Appetite
Vomiting
2. Shigellosis
RULE IN RULE OUT
Fever Bloody Diarrhea
Watery Diarrhea Incubation Period of 1-4 weeks
Abdominal Pain Foul Smelling Stool
Loss of Appetite
CASE DISCUSSION
Gastroenteritis (also known as gastric flu, stomach bug, stomach flu, gastro and stomach virus)
is marked by inflammation of the gastrointestinal tract involving both the stomach and small
intestine resulting in diarrhea, vomiting and abdominal cramps.
Etiology:
a. Viral
• Rotavirus
• Norovirus
• adenovirus and astrovirus
b. Bacterial
• Campylobacter jejuni • Shigella dysenteriae
• Chlostridium difficile • Escherichia coli
• Salmonella •Staphylococcus aureus
c. Protozoal
• Entamoeba histolytica
Transmission
• Fecal-oral route
• Via contaminated water
• People sharing contaminated objects
• Bottle-feeding using improperly sanitized bottles
Signs and symptoms
• diarrhea Other possible signs and symptoms include:
• nausea and vomiting •low-grade fever to 100⁰F (37.8⁰C)
• abdominal cramps • malaise
• borborygmi • tenesmus
Risk factors:
• age – the younger the child, the greater • climate
the susceptibility and severity • poor hygiene
• weak immune system • improper food handling
• environment
Complications
• dehydration • malnutrition
• electrolyte imbalance • pernicious anemia
• shock
Pathophysiology
AGE is a disease affecting the stomach and small and large intestine. Causes of
infectious gastroenteritis include bacterial, viral, and/or parasitic pathogens. These pathogens
can be invasive and cause cell damage and produce toxins. Or noninvasive and damage mainly
occurs through enterotoxin production. The resulting mucosal damage increases permeability
and peristaltic movement and impairs intestinal absorption, resulting in diarrhea and other
symptoms. The major metabolic disorders include maldigestion and malabsorption due to
impaired intestinal mucosal surfaces with consequences of hypotonic dehydration and
metabolic acidosis, which can have severe complications.
Gastroenteritis is usually self-limiting in 3–4 days. Parasitic gastroenteritis may last
longer. Life-threatening cases occur mostly in young children and the elderly.
Diagnostic Tests:
CBC – to determine plasma volume by hematocrit; infection by WBC count and
differential
Serum Electrolytes
Fecalysis
Urinalysis
Chest X-Ray
Fecal Occult Blood Test
Management:
A. Non-pharmacological therapy
(Dietary Management)
• Rehydration with proper electrolytes is critical for treatment
• Oral rehydration solutions such as Pedialyte or other commercially prepared ORS
For homemade ORS, mix 2 tablespoons of sugar with ¼ teaspoon of table salt in 1L
(1 qt) of clean or previously boiled water.
Advise SO to be very careful to mix the correct amounts. Too much sugar can make
the diarrhea worse. Too much salt can be extremely harmful to the child.
• After every bout of loose motion, feed breast milk/formula or offer a few
teaspoons of drinks like water, buttermilk etc.
• After 24 hours without vomiting, begin to offer soft bland foods such as the BRATS
diet (Bananas, Rice, Applesauce without sugar, dry Toast, and Saltine crackers)
• Small frequent feedings, preferably easily digestible foods
B. Medical Management
- Medications are normally not necessary, although it may be used to help
relieve symptoms (antidiarrheals and antiemetics). Antibiotics are only used
for bacterial and parasitic pathogens
a. Antiemetics
. • ex. Ondansetron
b. Antimicrobial Agents
•ex. Ampicillin
• Clindamycin
• trimethoprim – sulfamethoxazole
c. Antimotility agents
• ex. Loperamide
• Monitor Intake and Output - including oral and I.V. fluids, fluid loss from diarrhea,
urine output, and vomitus; monitor weight
• Provide family education and health maintenance
• Teach proper hygiene, food preparation, handling, and storage, and other ways
for prevention such as breast-feeding of infants – one of the many benefits of
breastmilk is that it contains antibodies which help protect against illnesses such
as tummy bugs (gastroenteritis)
