Ms. AF, 8-year-old Malay student was admitted yesterday with a complaint of vomiting and diarrhea for a day. She vomited 10 times yesterday which was watery in nature with no food particles, two table spoons in amount and it was colourless. There was no blood associated with it. She ate at her school's canteen during lunch time with her sister but there was no one else in the family that was having the same problem. While for her diarrhea, she had it for 6 times yesterday. It was yellowish, loose and filled up the whole toilet bowl. There was no blood but she experienced abdominal pain throughout the day.
Basically, that was the summary of a patient that we discussed during our CP last time. We need to think of some investigations to come up with a diagnosis and some plans to manage the patient.
Do u guys have an offer to make about the investigations and also the plans?
I bet u guys already have the answer isn't it?
Yup.. The investigations that should be done are:
- renal profile : to check the electrolyte levels, whether any imbalance exists
- stool culture & sensitivity : to detect the type of organism that may cause the diarrhea
The diagnosis : Acute gastroenteritis
Plans:
- Hydrate the patient
- Monitor vital signs
At the end of the day, the things that i learned was:
- to know how well the patient is, we can deduct it from his activity, appetite and sleep pattern
- to know whether the patient is dehydrated or not, check his urine volume and frequency
- to ask about immunisation status, look at the card or ask when is the last time that the patient had his vaccination
- for developmental history in a student, ask about the academic's performance which consists of his level in the class and the scores on the subjects
- for general examination, Dr ML wants us to mention about capillary refill time, clubbing, pallor, jaundice, cyanosis and edema
- if someone is at home and suddenly develops vomiting and diarrhea, isotonic drinks can maintain the hydration status
- oral rehydration salt (ORS) and banana have potassium which can maintain the electrolytes level in the body
- if a small kid can't tolerate orally, ice-cream is given because it is soothing to the mouth and it has enough calories for the kid
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