Background
- Broad differential: Gastrointestinal, Neurologic, Metabolic, Respiratory, Renal, Infectious, Endocrine, Toxin-related, Behavioral
Clinical Features
- Assess general appearance and behavior
- Evaluate volume status
- Abdominal and genitourinary examinations are important for potential surgical causes
Differential Diagnosis
Newborn
|
'
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Obstructive intestinal anomalies |
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Neurologic |
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Renal |
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Infectious |
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Metabolic/endocrine |
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Miscellaneous |
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Infant (<12 mo)
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'
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Obstructive intestinal anomalies |
Pyloric stenosis, malrotation ± volvulus, incarcerated hernia, Hirschsprung disease, enteric duplications, intussusception, foreign body, bezoars, Meckel diverticulum
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Neurologic |
Intracranial bleed/mass, hydrocephalus, cerebral edema
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Renal |
Urinary tract infection, obstructive uropathy, renal insufficiency
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Infectious |
Viral illness, gastroenteritis, meningitis, sepsis, otitis media, pneumonia, pertussis, hepatitis
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Metabolic/endocrine |
Inborn errors of metabolism, adrenal insufficiency, renal tubular acidosis
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Miscellaneous |
Ileus, gastroesophageal reflux, post-tussive, peritonitis, drug overdose
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Child (>12 mo)
|
'
|
Obstructive intestinal anomalies |
Malrotation ± volvulus, incarcerated hernia, Hirschsprung disease, intussusception, foreign body, bezoars, Meckel diverticulum, acquired esophageal stricture, peptic ulcer disease, adhesions, superior mesenteric artery syndrome
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Neurologic |
Intracranial bleed/mass, cerebral edema, postconcussive, migraine
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Renal |
Urinary tract infection, obstructive uropathy, renal insufficiency
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Infectious |
Viral illness, gastroenteritis, meningitis, sepsis, otitis media, pneumonia, hepatitis, streptococcal pharyngitis
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Metabolic/endocrine |
Inborn errors of metabolism, adrenal insufficiency, renal tubular acidosis, diabetes mellitus, Reye syndrome, porphyria
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Miscellaneous |
Ileus, gastroesophageal reflux, post-tussive, peritonitis, drug overdose, appendicitis, pancreatitis, gastritis, Crohn disease, pregnancy, psychogenic, cyclic vomiting syndrome
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Diagnosis
- Significantly dehydrated if has 2 or more of the following (LR+ 6.1, CI:3.8-9.8)[1]
- Prolonged capillary refill (>2 sec)
- Dry mucous membranes
- Absence of tears
- Abnormal overall appearance
Management
- Largely depends on etiology
- If ill appearing, establish rapid IV access, or if needed IO.
- Rapid finger stick blood sugar
- Point of care pH and electrolytes (iSTAT)
Disposition
- If self-limited etiology
- Well appearing
- Tolerating fluids
- Close follow-up as outpatient
- If dangerous etiology or unclear
- IV access
- Continuing resuscitation
- Admit for treatment and/or observation
See Also
External Links
Pediatric Emergency Playbook -- Vomiting in the Young Child: Nothing or Nightmare
References
- ↑ Gorelick MH et al. Validity and reliability of clinical signs in the diagnosis of dehydration in children. Pediatrics. 1997; 99(5):E6