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