Bored review 8/26/14- DIARRHEA

by sbogoch • August 26, 2014 • Comments Off

A 22-month-old boy presents to the ED with his parents following 4 days of vomiting and diarrhea. The parents report that the child has not been playful and has had decreased wet diapers. The mother reports that the child is drinking small amounts, but is vomiting 4-5 times per day. Physical exam shows dry oral mucosa, sunken eyes, and a crying (no tears) toddler. The child clings to his mother during the exam. What is the FIRST sign of moderate volume depletion in this age group?

The Goods

Tachycardia! Children are heart-rate-dependent for increasing cardiac output. When volume depletion occurs, the first hard sign is tachycardia. Why not try some oral antiemetics (ondansetron 0.15mg/kg) with an attempt at rehydration. Alternatively, this child could benefit from a 20ml/kg bolus of normal saline.

By Dr Sally Bogoch and Dr Andrew Grock

Tintinalli’s 7th ed

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