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INFORMATION FOR CANDIDATE:

You are the GP in a rural setting. A young father,

Ray Jones brings in his 6 months old son,

Steven, with diarrhoea which started yesterday.

e has been !assing watery stools for "#$ times

a day since yesterday.

YOUR TASK IS TO:

%. &a'e a further history

(. )*amine the child +as' findings from thee*aminer

". -anage the !atient.

 

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HOPC:

You are the GP in a rural setting. A young father, Ray Jones brings in his 6 months old

son, Steven, with diarrhoea which started yesterday. e has been !assing watery stools for 

"#$ times a day since yesterday. &here was no blood or mucous. is older brother, James,

had diarrhea ( wee's ago which settled s!ontaneously after "#$ days.

Steven is feeding well, alert, not drowsy, no vomiting, no fever or rash./01S 2uestions3

3 normal birth on term

/3 has not had immuni4ations because mum and dad believed it was not necessary.

 03 breastfed, no !roblems

13 normal develo!ment so far, 5th !ercentile re growth and weight, no visual or hearing

 !roblems

S3 one sibling as mentioned above

PHx. + FHx.: unremar'able

SHx: lives with mum, dad and older brother, no !roblems at home +(5 minutes from

hos!ital7EXAMINATION: 2uite well loo'ing 6 months old baby boy with normal vital signs,

normal s'in turgor, ca!illary refill and moist mucous membranes, anterior fontanel not

sun'en in.

)0& e*amination and the rest of the !hysical e*amination are normal.

 

INVESTIGATIONS:

• stool for microsco!y, culture and sensitivity

DIAGNOSIS: DIARRHOEA due to aute !"#et!ou$ %a$t&oe"te&!t!$ '(o$t )!*e),!&a)- !" a" u"!((u"!ed /!)d

1iarrhoea is defined as a measured stool volume 8 % ml9'g9day with the consistency

+loose or watery and fre2uency +8 " 9 ($ hours im!ortant factors7

:linical signs are vomiting, fever and watery diarrhoea often with !oor feeding leading to

dehydration and electrolyte imbalance7

lood and9or mucous in the stool with fre2uent small volume bowel actions and

abdominal !ains suggest bacterial gastroenteritis7

/n Australia, diarrhea is most commonly caused by rota virus7

;e stratify diarrhoea into3

%. -/ body weight loss, decreased !eri!heral !erfusion, thirsty, alert,

restless(. -?1)RA&)3 6#@> body weight loss and sym!toms as above and in addition

ra!id !ulse, sun'en eyes and fontanelle with dry mucous membranes, ca!illary

refill delayed +%#( seconds, sometrimes dee! acidotic breathing

". S))R)3 8@> body weight loss and all of the above signs, !lus drowy, lim!, cold

sweaty, cyanotic limbs, ra!id and feeble !ulse, ca!illary refill delayed 8 ( seconds

DIFFERENTIA0 DIAGNOSES:

• SYS&)-/: /0B):&/?0S3 C&/, !neumonia, other se!sis

• SCRG/:A< :?01/&/?0S3 a!!endicitis, intussusce!tion, isrschs!rung disease

• Antibiotic diarrhoea, haemolytic uraemic syndrome

 

MANAGEMENT:

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1e!ending on the degree of diarrhea and dehydration an a!!ro!riate !lan for re#hydration

+oral rehydration solutions 9 ?RS, nasogastric or i.v. and nutritional su!!ort needs to be

im!lemented7

%. -/ dehydration3

E.5> of % 'g F E5 mlmaintenance of % ml9'g F % ml

&?&A