Clinical case

David, 10 month
Went to the hospital:

 Due to repeated vomiting, increased

body temperature to 38.5 ° C, liquid
stool, anxiety, loss of appetite,
weakness.
What questions should I ask
the child's mother?
 Is the child sick for a few days?
 How did the disease start (with vomiting or
liquid stool, temperature)?
 The nature of the fever – to what numbers,
during the increase in temperature, was there a
cold of the extremities , chills, pallor of the skin?
 What connects the disease – whether there was
contact with a person who had vomiting or loose
stools, what the child ate in the last three days.
 Did you get treatment at home?
 If you have received which drugs, at
what dose, how many days?
 Was the effect of the treatment improved
or unchanged?
General questions asked to all
patients with acute intestinal
infection:
How many days has the patient been ill and
how did the disease start?
The nature of the stools (mucous, mixed with
blood, watery)Stool frequency
Signs of dehydration (thirst, decreased
diuresis)Vaccination Organization (whether he
goes to school or kindergarten)
Eating expired foods
The history of life (illness, allergoanamnez)
 • FROM ANAMNESIS:
• The child became acutely ill 3 days ago. The beginning of the
disease with vomiting 3-4 times, increase in body temperature
to 38.5 ° C.
• In the evening of the same day, liquid stool appeared up to 4-5
times.
• Persistent fever for three days, sometimes up to febrile
numbers.
• After taking paracetamol syrup the temperature decreased for a
while Tonight, repeated vomiting, liquid stool up to 10 times.
• At home, mother gave ½ tablet of furazolidone 2 times a day,
but there was no effect
 What are the algorithm examination of the
patient with the problem of diarrhea according
to IMCI.What additional anamnestic and
clinical data is needed to determine the
disease?
• General condition
• The presence of sunken eyes
• Thirsty, drinks greedily, or can't drink at all
• The condition of the skin folds
• To determine the treatment
• Treat
Examine, feel:
• The child is lethargic or unconscious
Restless or painfully irritated
• Offer your child liquids:Child:Can't drink
liquid or drinks poorly
• Thirsty, drinking greedily
Assessment of the condition of
the skin fold
 The skin fold is straightened immediately
 The skin fold straightens slowly (up to 2
seconds)
 The skin fold straightens very slowly (more
than 2 seconds)
Questions on IMCI

 Can a child drink or suck the breast?

 Does he vomit after every meal or drink?
 Whether the child has convulsions during this illness?
 On the issue of diarrhea:How long is diarrhea?
 Is there blood in the stool?
 The following slides show the patient's
appearance
Abdominal area
At survey

 The child is restless, painfully irritated.

Temperature 38.1 C, there is thirst, but due to
repeated vomiting can not drink. The skin fold
straightens slowly. His eyes sunken. My
stomach is swollen.
In the abdomen

 When palpation rumbling along the bowel.

Stool 14-15 times a day, in large quantities
watery, foamy, with a loud discharge of gas.
 Assign a survey plan to this child
Survey plan

 General blood test General urine analysis

 Feces on the simplest and I/GL
 #3Coprogram #3Tank fecal culture for intestinal group
 3Buck fecal culture on UPF
 Stool for rotavirus antigens using the ELISA method
Laboratory data

 General blood test:

 Нв – 134г/л, Er – 4,00х1012/л, L –
8,0х109/л, п/я – 3 %, с/я – 39 %, E – 2%, л –
50 %, м – 6 %, СОЭ – 10 мм/час.
General urine analysis

color-straw-yellow, transparency-full, relative

density-1013, traces of protein, white blood
cells-2-3-1 in p / Zr, phosphates +++.
Coprogram

 Color-greenish-yellow, consistency-liquid,
undigested fiber+++, muscle fibers+++,
starch+++, neutral fats +++, L-3-4 in the p / W,
mucus +, iodophilic bacteria +++ .
Bacteriological examination:

 Feces on the intestinal group (Shigella,

Salmonella, Escherichia) – negative Cal on
UPF-negativeStool for rotaviruses using the
ELISA method-positive result
 Classify the child's condition with the problem
of diarrhea the IMCI program
 Make a preliminary diagnosis
 On IMCI: Severe dehydration.
 Rotavirus infection: gastroenteritis, severe
degrees of severity.
Assign the treatment of
dehydration according to
the program IMCI
 PLAN B
 Intravenous fluid administration to a child with severe dehydration:
less than 12 months of age: first enter 30 ml / kg for 1 hour, then enter
70 ml/kg for 5 hours;
 if you are older than 12 months, enter 30 ml / kg in 30 minutes, then
enter 70 ml/kg in 2.5 hours;
 repeat the assessment every 15-30 minutes. If the hydration status does
not improve, increase the rate of liquid drip. Also give ORS solutions
(about 5 ml / kg / h) as soon as the child can drink: usually after 3-4
hours (infants) or 1-2 hours (older children);
 re-evaluate the condition of a child under 12 months of age in 6 hours,
and children over 12 months of age – in 3 hours. Determine the degree
of dehydration. Then select the appropriate plan (A, B, or C) to
continue treatment.
Indications for parenteral rehydration and detoxification in a
hospital setting:
severe forms of dehydration with signs of hypovolemic shock;
infectious and toxic shock; neurotoxicosis;
severe forms of dehydration; combination of exicosis (of any degree)
with severe intoxication; indomitable vomiting; ineffectiveness of oral
rehydration for 8 hours in plan B or transition from moderate to severe
dehydration.
 THANKS FOR ATTENTION!