Acute vomiting in infants and children: Case

This toddler has acute viral gastroenteritis with some dehydration. The vomiting followed by watery diarrhoea, the low-grade fever, the sick household contact, the non-bilious vomit and the soft non-tender abdomen point clearly to gastroenteritis, and the sunken eyes and dry mucous membranes with preserved tears and normal capillary refill place her in the mild-to-moderate dehydration range. The task is to rehydrate her by the least invasive effective route while actively confirming that this is not a surgical or metabolic mimic. ^[1]

Clinical findings

The reassuring findings are as important as the abnormal ones. Her vomit is milky and never green, her abdomen is soft, non-tender and not distended with active bowel sounds, and she is consolable and produces tears, all of which argue against a surgical abdomen and against severe dehydration or shock. The abnormal findings are the tachycardia, the slightly sunken eyes and the dry mucous membranes, which together indicate some dehydration but not the severe end. ^[2]

The candidate should grade the dehydration formally rather than by impression. On the Clinical Dehydration Scale, which scores general appearance, eyes, mucous membranes and tears, this child sits in the some-dehydration band, and this validated score predicts the need for intravenous fluids and length of stay better than clinician gestalt. The problem representation is a well-appearing toddler with gastroenteritis and some dehydration, suitable for a trial of oral rehydration. ^[2]