A 2 year old boy is brought into the Emergency Department with his parents. He has had a 48 hour history of diarrhoea and vomiting. He has also had a mild amount of abdominal pain.

His mother is also concerned because he hasn't eaten or drunk anything over the last day, and also isn't quite himself. There are no unwell contacts and he is normally fit and well. His vaccinations are all up to date and he has no remarkable social history or family history.

On Examination

  • Obs: HR 160, RR 34, SpO2 – 100%, Temp 37.2 and capillary refill 4seconds

  • CVS – Nil remarkable apart from observations

  • Respiratory – Nil remarkable apart from observations

  • Abdominal – Difficult to perform but child appears to have dry mucous membranes and generalised abdominal tenderness, no current guarding or peritonism.

  • Neuro – Child is quiet and uninterested in toys but responds to voice.

Questions

Answer one question before attending the face-to-face teaching session. Add comments to answers already given if you think it's appropriate. The first part of teaching will be spent discussing this case:

  1. What would your current differential diagnosis include and why?

  2. Describe your initial management for this patient?

  3. What are the concerning features in the history and examination?

  4. Are there any specific investigations you would like to perform?

  5. Assuming he responds to treatment and his capillary refill time is now normal, how would manage this patient further?

    You decide to admit this patient, however before he goes to the ward a nurse checks his BM and it is found to be 2.2

  6. How would you manage this patient now?

  7. The patient improves and is due to be discharged in a few days from the ward, what advice would you give as the discharging doctor?

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