Diarrhoea Presentation

Pediatrics Case Presentation
Presentors:-
 Roll no- 49, 123
 (Batch 2016)
Case description
• I am presenting a case of Nandu , 2 year old,male ,Hindu by religion, resident of Nand
Nagri, Delhi. The informant is his mother and the history seems to be reliable. The child
is brought to GTB hospital paediatrics emergency on 1 st September 2020.
Chief complaint
• Loose stools since 5 days

• Vomiting since 2 days
• Reduced oral acceptance since 1 day
History of present illness
Loose stools since 5 days
• Onset-acute
• Duration-5 days
• Watery in consistency, 5-7 episodes/day
• Greenish in colour, foul smelling, non greasy
• No blood or mucus
• Associated with- loss of appetite, lethargy,
• Negative history of
Fever, abdominal pain/cramps,.
Vomiting
• Onset- Acute
• Duration-2 days, 3-4 episodes/day
• Non projectile, Non bilious, not blood tinged
• Contained food particles, but not a/w immediate food intake
Decreased oral acceptance
• Since 1 day
• Decreased intake including water
• Lethargic
No history of
• Fever
• Runny nose/ear discharge
• Cough/fast breathing
• Crying while passing urine
• Drug intake
• Consumption of food from outside
• Decreased urine output

• Abnormal body movement
• Abdominal distension
• Altered sensorium
Past history
• No history of similar episodes in the past

• No history of previous hospitalization or any prolonged illness
• No history of rash
• No history of prolonged drug intake
• No history of tuberculosis in the past
• No history of any drug allergy
Drug and Treatment history
• ORS from Anganwadi

• Given 4-5 times a day
Antenatal , Postnatal , Neonatal history
• Child was born to 26 year old second para mother at term by vaginal delivery in GTB
hospital.
• Antenatal period was supervised ;mother had taken IFA supplementation for a duration of
6 months, received TT injection.
• Baby cried immediately at birth and weighed 2.6 kg.
• Immediate postnatal and neonatal period were uneventful; no NICU stay
• Breast feeding was started within 2 hours of delivery
Developmental milestones
• Gross motor – climbs upstairs 2 feet/step

• Fine motor milestone- makes tower of 6-7 cubes
• Cognitive- points at 4-6 body parts
• Language- can speak two word sentence
• Social – dry by day, but not by night yet
Immunization history
 Immunized (pending- Typhoid vaccination)

Dietary history
• Diet history is taken by 24 hr recall method

• Age of child-2 years
• Energy intake-672Kcal/day against required 1060 Kcal/day
• Protein intake-13.3 gm/day against required 16.7 g/day
• Energy deficit-37%
• Protein deficit-21%
Dietary intake (24 hr recall)
Time Food items Amount Calorie Protein(g)

consumed (grams) (kcal)
Morning ½ cup 100 100 1.75
khichdi
1 cup milk 100mL 72 3.3
Afternoon ½ cup 100 100 1.75
khichdi
Good day 2 pieces 100 1.4
biscuit
Evening Good day 3 pieces 150 2.1
biscuit
Dinner Paratha 1 piece 150 3
Pre-sleep - - - -
672 13.3
Socioeconomic history
• Child belongs to a nuclear family with 4 living members residing in a 2 room pukka
house in Nand Nagri with separate kitchen and bathroom.
• Inadequate ventilation
• Water supply from Delhi Jal Board, water boiled and stored in lid covered containers.
• Father educated upto 10th class is an unskilled worker(farmer) and earns 10,000 per
month
• Mother is educated upto 10th class and homemaker
• Family belongs to Upper lower SES (score=9, class=IV) by Modified Kuppuswamy
Scale.(add scale)
Family history
• Non consanguineous marriage

• Total members-4
• Sibling- elder sister 5 years old
• No h/o similar complaints in family/elder sibling
Examination
•The patient was examined in a supine position and lying in bed.

•He was lethargic, not responding to commands.
Vitals
• Temperature: 97 F, with cold peripheries

• Pulse: 132 bpm measured in the right radial artery, regular rhythm, low volume, normal
character, with no radiofemoral delay.
• Respiration: respiratory rate 28/min, thoracoabdominal breathing, normal rhythm, no use
of accessory respiratory muscles.
• Blood pressure: 80/50 mmHg measured in the right upper arm.
• Capillary filling time: 3 seconds
• Child is lethargic
• Not able to drink and has sunken eyes with dry mucosa
• On skin pinch skin goes back very slowly
Anthropometry
Anthropometric Recorded Expected(50th Inference

measure percentile)
Weight for age 9.7 kg 12.2 Between -2SD to -
3SD(moderate underweight)
Height for age 87 cm 87.8 Between -1SD to +1SD
Weight for height 9.7 kg 12 Between -2SD to -3SD
MUAC- 12.1 cm (moderate malnutrition)

General Physical examination
Pallor is present
 Icterus: absent
 Cyanosis: absent
 Clubbing: absent
 Lymph nodes: no significant lymphadenopathy seen
 Edema: absent
 Head: normal in shape and size, fontanelles closed, normal hair, no frontal bossing
 Face: normal symmetry,
 Eyes: sunken, no ulceration or bitots spots
 Mouth and oral cavity: no glossitis, cheilosis, no bleeding gums, dental caries,
dry mucous membranes
 Chest and abdomen: no obvious deformity
 Skin: normal
 Limbs: BCG scar on left shoulder
Abdomen:
 Inspection: symmetrical, non distended, no scar marks, umbilicus inverted and in
normal position, all quadrants moving equally with respiration, genitalia normal
 Palpation:
 Superficial – no local rise in temperature, no guarding/rigidity, hernial sites free
 Deep - Liver is just palpable, Spleen is not palpable,
 Percussion: Tympanic, no dullnes
 Auscultation: bowel sounds heard
CNS
 Lethargic
 Normal tone, power >3/5
 DTR 2+
 No neck rigidity
CVS:
 Apex beat is present in the fourth intercostal space in the midclavicular line.
 S1 and S2 are heard.
 No murmurs
Respiratory system:
 Bilaterally equal air entry, normovesicular breath sounds heard
 No adventitious sounds
Summary
Nandu, a 2-year-old boy presented to the pediatric casualty with complaints of diarrhea for
past 5 days, vomiting for past 2 days, decreased feeding for 1 day.
On examination, the child was lethargic with oral mucosa dry, skin pinch delayed. Other
systemic examinations were normal. Capillary refill time was 3 sec.
Pre illness calorie intake was 672 kcal and protein intake 13.3 gram per day, with a deficit of
37% and 21% respectively. The child is moderately underweight.
A diagnosis of ‘Acute gastroenteritis with severe dehydration with moderate acute
malnutrition is made’ is made.

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Pediatrics Case Presentation

• Loose stools since 5 days

• Decreased urine output

• No history of similar episodes in the past

• ORS from Anganwadi

• Gross motor – climbs upstairs 2 feet/step

 Immunized (pending- Typhoid vaccination)

• Diet history is taken by 24 hr recall method

Time Food items Amount Calorie Protein(g)

• Non consanguineous marriage

•The patient was examined in a supine position and lying in bed.

• Temperature: 97 F, with cold peripheries

Anthropometric Recorded Expected(50th Inference

MUAC- 12.1 cm (moderate malnutrition)

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