Author: Francesca Cleugh / Editor: Nicola McDonald / Reviewer: Michael Perry / Codes: HCPS4i / Published: 19/02/2019
An 8-month-old boy is brought to A&E by his mother. He became unwell 2 days ago with vomiting and abdominal pain. He has been coryzal for a few days and had mild fevers that responded to oral paracetamol at home, but has not had fever overnight. He attended A&E yesterday lunchtime with the same symptoms. He tolerated a fluid challenge so was discharged home after a period of observation during which he perked up. However his mother is concerned this morning as his vomiting has persisted and she is struggling to get him to take fluids. He is also having increasing episodes of drawing up his legs, appearing very unsettled and crying, and his mother feels this is due to intermittent abdominal pain. His last wet nappy was yesterday evening. He has vomited 3 times overnight and approximately 5 times in total yesterday. They are non bilious vomits. He last opened his bowels yesterday morning and it was a little loose. He has been unsettled most of the night, but this morning seems quiet and his mother is worried about dehydration.
He was born at term, with no past medical history of note. He is up to date with immunisations and has no known allergies. His mother reports to have had diarrhoea and vomiting herself a few days ago, but is now better. His father is well and is at home with the 3-year-old sibling who has coryzal symptoms but is otherwise well. There has been no foreign travel.
On examination he is pale, lethargic and floppy. He has dry lips. Central CRT is <2 seconds, but peripherally 3 seconds. Temp 36.4, HR 155, RR28, sat 100% air. He has normal heart sounds and his chest is clear. His abdomen is soft. He is coryzal, but ENT examination is otherwise normal.