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

2. O.P. 7 months, male August 20, 2010 157-2 M. Dela Fuente St. Sampaloc, Manila Roman Catholic Informant: Parents Reliability: Good DIARRHEA

3. 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

4. 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

5. 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

6. 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

7. NEONATAL HISTORY Born at 39-40 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

8. 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

9. 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

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

11. PAST MEDICAL HISTORY October 2010 – Pneumonia January 2011 - Diarrhea

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

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

14. 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

15. 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)

16. 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

17. 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

18. 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:

19. 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

20. 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

21. APPROACH TO DIAGNOSIS

22. CLINICAL IMPRESSION ACUTE INFECTIOUS DIARRHEA WITH MODERATE SIGNS OF DEHYDRATION