Acute gastroenteritis and infectious diarrhoea — branching viva

Opening — framing the problem

The examiner begins: an 18-month-old has two days of watery diarrhoea and vomiting, is restless with sunken eyes and a slow skin pinch, but is alert with warm peripheries. Talk me through your approach. ^{[1] [3]}

I would frame this as acute gastroenteritis and make my first task the grading of dehydration, because that decides everything. The combination of sunken eyes, dry mucosa, a slow skin pinch and prolonged capillary refill in an alert child with warm peripheries fits some, or mild-to-moderate, dehydration rather than shock. I would rehydrate him orally while excluding a surgical mimic. ^{[3] [1]}