MENDOZA, DONNE MENDOZA, GRACIELLE MENDOZA, TRISHA MINDANAO, MALVIN ACE INFECTIOUS DISEASE CONFERENCE

O.P. 7 months, male August 20, M. Dela Fuente St. Sampaloc, Manila Roman Catholic Informant: Parents Reliability: Good DIARRHEA

HISTORY OF PRESENT ILLNESS 1 hr PTA 3 episodes of vomiting Non-projectile, non-bilous. Yellowish, admixed with mucoid material, amounting to 3 tbsp/episode - 4 episodes of loose, mucoid, yellowish stool, altogether amounting to 1 cup - Noted to be weak-looking, w/ cold clammy skin 30 min PTA ADMISSION

REVIEW OF SYSTEMS Cutaneous: (-) rashes, (-) pruritus HEENT: (-) nasoaural discharge, (-) eye discharge, (-) sore throat Respiratory: (-) dyspnea, (-) chest pain Cardiovascular: (-) palpitations, (-) cyanosis, (-) easy fatigability Gastrointestinal: SEE HPI

REVIEW OF SYSTEMS Genitourinary: (-) dysuria (-) hematuria Musculoskeletal: (-) weakness, (-)swelling Hematopoietic: (-) easy bruisability, (-) bleeding Endocrine: (-) polyuria, polydipsia, polyphagia Nervous/Behavior: (-) headache, (-) seizures, (-)tremors, (-) loss of consciousness

GESTATIONAL HISTORY Born to a 22 y/o G1P0 mother with a common law 27 y/o policeman partner Regular prenatal check-up since 5 mo AOG Hep B screening and OGCT were not done No history of alcohol intake, smoking or exposure to radiation No illnesses noted during pregnancy

NEONATAL HISTORY Born at weeks AOG Live, singleton, delivered via NSD APGAR score 8-9 Birth weight = 2.7 kg Birth length – unrecalled 1-day stay at the nursery No complications noted during delivery

FEEDING HISTORY Breastfed exclusively for 1 month More than 8 times per day or everytime child cries Shifted to milk formula Mother claimed she was not producing enough milk Bottlefed since 2 months until present 2-5 months: S26 – 1:2 dilution, 4 oz per feeding, 6x /day 6 months to present: Bonamil – 1:2 dilution, 8 oz per feeding, 4-5x/day Complementary feeding started at 6 months Cerelac and pureed food

DEVELOPMENT/BEHAVIORAL HISOTRY Gross motor With good head control, can crawl, rolls over, sits with support Fine motor Transfers object from 1 hand to another Language Imitates speech sounds Personal Social Laughs and plays with examiner

IMMUNIZATIONS HEALTH CENTER BCG – 1 dose Hep B – 1 dose DPT – 3 doses OPV – 3 doses Hib – 1 dose

PAST MEDICAL HISTORY October 2010 – Pneumonia January Diarrhea

FAMILY HISTORY (+) HPN – maternal grandmother (-) DM, goiter, asthma, cancer, TB

FAMILY PROFILE RelationAge Educational Attainment OccupationHealth Mother22 High school graduate noneHealthy Father27College graduatePolicemanHealthy

PERSONAL, SOCIOECONIMIC AND ENVIRONMENTAL HISTORY Apartment with both parents Well-ventilated, well-lit Drinking water is purified Garbage is not segregated but collected everyday No nearby factories, no pets

PHYSICAL EXAMINATION Alert, awake, weak-looking, with moderate signs of dehydration, drinks eagerly, not in cardiorespiratory distress VS: CR 160 RR 40 T 36.9 Wt 6 kg. (z= 0) Lt. 73 cm (z= 0) AC: 43 cm BMI 11 (z= below -3) wt. for Ht. (z= below -3)

PHYSICAL EXAMINATION Warm, dry skin, no active dermatoses Pink palpebral conjunctiva, anicteric sclerae, (+) sunken eyeballs No tragal tenderness, non-hyperemic EAC, (+) retained cerumen, AU, intact tympanic membrane, no aural discharge AU Midline septum, turbinates not congested, no nasal discharge

PHYSICAL EXAMINATION Dry buccal mucosa, no oral lesions, to non- hyperemic posterior pharyngeal wall, tonsils not enlarged Supple neck, no palpable cervical lymphadenopathies or anterior neck masses Symmetrical chest expansion, no retractions, clear breath sounds Adynamic precordium, apex beat 4 th LICS MCL, no heaves, thrills, murmurs

PHYSICAL EXAMINATION Globular abdomen, NABS, soft, non- tender, no mass palpated Pulses full and equal, no cyanosis, no edema No genital lesions, no phimosis DRE:

NEUROLOGIC EXAMINATION Mental Status: alert, awake Cranial Nerves are intact: intact EOM; no ptosis; no jaw deviation; smiles, open and close his eyes, no facial asymmetry; midline uvula, no tongue atrophy, no fasciculations, no deviation No Babinski, no nuchal rigidity

SALIENT FEATURES POSITIVE 7 mo/male Diarrhea – mucoid stools Vomiting Weak-looking, with cold clammy skin Past medical history of diarrhea (+) sunken eyeballs, dry buccal mucosa, drinks eagerly, good skin turgor Soft abdomen, NABS, (-) masses NEGATIVE non-projectile, non-bilous vomiting (-) blood-streaked vomitus and stool (-) fever (-) abdominal pain

APPROACH TO DIAGNOSIS

CLINICAL IMPRESSION ACUTE INFECTIOUS DIARRHEA WITH MODERATE SIGNS OF DEHYDRATION