Acute GE (Diarrhea) in Children: Model Clinical Case and Viva Q&A

Patient Presentation

A 2-year-old male presents to the Emergency Department with a 2-day history of watery diarrhea (8-10 episodes/day), vomiting (6 episodes in the last 24 hours), and decreased oral intake. Parents report he had a low-grade fever (38.2°C) yesterday.

Key Presenting Symptoms:
  • Watery diarrhea - no blood or mucus
  • Non-bilious vomiting
  • Decreased appetite and fluid intake
  • Low-grade fever

Click to read about: ACUTE GASTROENTERITIS

Past Medical History

Previously healthy with normal growth and development. Vaccinations up to date, including rotavirus vaccine. No chronic medical conditions. No recent antibiotic use or travel history.

Physical Examination

Vital Signs:

  • Temperature: 38.0°C
  • Heart Rate: 130 beats/min
  • Respiratory Rate: 28 breaths/min
  • Blood Pressure: 90/60 mmHg
  • Weight: 12 kg (documented weight loss of 0.8 kg from last well-child visit 2 weeks ago)

Physical Findings:

  • General: Alert but irritable, appears moderately dehydrated
  • HEENT: Dry mucous membranes, sunken eyes, delayed capillary refill (2-3 seconds)
  • Cardiovascular: Tachycardic, normal heart sounds
  • Respiratory: Clear breath sounds bilaterally
  • Abdomen: Soft, non-tender, normal bowel sounds
  • Skin: Decreased skin turgor, delayed skin pinch return
  • Neurological: Age-appropriate, no focal deficits
Laboratory Findings

Basic Metabolic Panel:

  • Na+: 138 mEq/L (135-145)
  • K+: 3.3 mEq/L (3.5-5.0)
  • Cl-: 102 mEq/L (98-108)
  • HCO3-: 18 mEq/L (22-26)
  • BUN: 18 mg/dL (7-20)
  • Creatinine: 0.4 mg/dL (0.3-0.7)
  • Glucose: 85 mg/dL (70-100)

Other Studies:

  • Stool Studies: Negative for blood, leukocytes, and culture pending
  • Urinalysis: Specific gravity 1.025, otherwise normal
Assessment

Primary Diagnosis:

Acute viral gastroenteritis with moderate dehydration (6-9% fluid deficit)

Evidence Supporting Diagnosis:

  • Clinical presentation consistent with viral gastroenteritis
  • Physical exam findings indicating moderate dehydration
  • Laboratory findings showing mild metabolic acidosis and hypokalemia
  • Age and vaccination status suggesting rotavirus less likely
Dehydration Assessment:

Moderate dehydration (6-9%) based on:

  • Documented weight loss of ~6%
  • Delayed capillary refill
  • Decreased skin turgor
  • Tachycardia
  • Dry mucous membranes
Management Plan

Immediate Management:

  1. IV Fluid Rehydration:
    • Calculate deficit: 7% of 12 kg = 840 mL
    • Initial bolus: 20 mL/kg NS (240 mL) over 1 hour
    • Remaining deficit plus maintenance over 24 hours
  2. Electrolyte Replacement:
    • Add KCl 20 mEq/L to maintenance fluids after initial bolus
  3. Monitoring:
    • Vital signs q2h
    • Input/output tracking
    • Serial weight measurements
    • Repeat electrolytes in 4-6 hours

Discharge Criteria:

  • Adequate oral intake
  • Normal vital signs
  • Normalized electrolytes
  • Parent education completed
Learning Points

Key Clinical Pearls:

  1. Accurate assessment of dehydration severity is crucial for appropriate management
  2. Weight loss is the most objective measure of dehydration
  3. Most cases are viral and self-limiting; antibiotics are rarely indicated
  4. Early rehydration and electrolyte correction improve outcomes
  5. Regular reassessment is essential to guide therapy

Differential Diagnosis to Consider:

  • Bacterial gastroenteritis
  • Malabsorption syndromes
  • Food intolerance
  • Systemic infection
  • Surgical abdomen


Clinical Presentations of Diarrhea in Children

  1. Acute Watery Diarrhea

    Characterized by sudden onset of frequent, watery stools without blood or mucus. Often associated with vomiting and fever. Common causes include viral gastroenteritis (e.g., rotavirus, norovirus) and enterotoxigenic E. coli.

  2. Dysentery (Bloody Diarrhea)

    Presents with frequent, small-volume stools containing visible blood and mucus. Often accompanied by abdominal pain, tenesmus, and fever. Common causes include Shigella, Campylobacter, and invasive E. coli.

  3. Persistent Diarrhea

    Diarrhea lasting 14 days or more. May be associated with malnutrition, weight loss, and micronutrient deficiencies. Causes include persistent infections, post-infectious irritable bowel syndrome, or underlying gastrointestinal disorders.

  4. Chronic Diarrhea

    Diarrhea lasting more than 30 days. May present with failure to thrive, anemia, and other signs of malnutrition. Causes include celiac disease, inflammatory bowel disease, cystic fibrosis, or congenital disorders.

  5. Secretory Diarrhea

    Characterized by large-volume, watery stools that persist even with fasting. Often associated with electrolyte imbalances. Causes include cholera, carcinoid syndrome, or congenital chloride diarrhea.

  6. Osmotic Diarrhea

    Occurs due to the presence of non-absorbable solutes in the intestine. Typically improves with fasting. Causes include lactose intolerance, sorbitol ingestion, or malabsorption syndromes.

  7. Toddler's Diarrhea

    Chronic, non-specific diarrhea in otherwise healthy young children. Characterized by loose, frequent stools, often containing undigested food particles. Usually resolves spontaneously by school age.



Knowledge Check: Question and Answers for Medical Students & Professionals

This interactive quiz component covers essential viva questions and answers. It includes 30 high-yield viva questions with detailed answers.

Question 1 of 30


Disclaimer

The notes provided on Pediatime are generated from online resources and AI sources and have been carefully checked for accuracy. However, these notes are not intended to replace standard textbooks. They are designed to serve as a quick review and revision tool for medical students and professionals, and to aid in theory exam preparation. For comprehensive learning, please refer to recommended textbooks and guidelines.



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