Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat Gastroenteritis and dehydration

Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat Case 1: 11 months old boy 2 day history of vomiting and diarrhea Older brother in daycare same symptoms last week last urine output this morning (now: 4pm) 4 diarrheas today, vomited 2 times parents can’t get her to drink. The two times she accepted fluid, she threw up

Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat Examination Uncomfortable, gives contact, no smile T 38,4 HR 135 skin turgor slightly reduced capillary refill time 2sec mucus membranes wet

Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat Lab CRP 8 Diagnosis? Admit to hospital? Other solutions?

Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat Viral gastroenteritis

Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat History Ensure correct diagnosis! (fever, gastroenteritis in the family/community, both vomiting and diarrea?) Duration Amount of ongoing losses Ability to maintain an adequate intake Urine output Weight loss –<5% mild –5-10% moderate –>10% severe

Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat Clinical examination Capillary refill time Skin turgor Respiratory rate Pulse Sunken fontanel Dry mucus membrane (blood pressure)

Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat Laboratory investigations bicarbonate level (<15-17) –OBS: profuse vomiting leads to metabolic alkalosis urea (Na, K, pH, Base Excess, kreatinin, Hb, WBC)

Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat Treatment Oral rehydration –Commercial solutions –Small amounts often with teaspoon/syringe Nasogastric tube –Continous supplement Intravenous –NaCl 20ml/kg

Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat Case 2: 3 months old girl 1 day history of vomiting (x1) and diarrhoea 3 stools/hour for the last 3 hours. Two large watery diarrhoeas while in your office Accepts some fluid without throwing up, but much less intake than usually Urine output unknown, all dipers are wet of diarrhoea. Slept much more than usual

Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat Examination Smiles, excellent contact. Acitvity looks fine HR 145, RF 50 Capillary refill time 2 sec Mucus membranes wet Turgor OK Admit to hospital?

Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat Case 3: 1,5 years old Smiles, excellent contact. Acitvity looks fine HR 145, RF 50 Capillary refill time 2 sec Mucus membranes wet Turgor OK

Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat Examination Uncomfortable, difficult to calm, keep crying T 40 HR 150 Skin turgor ok. Capillary refill time 3 sec. Distended abdomen, painful. Some bowel sounds presents Admit to hospital?