AGE IN PEDIATRICS CASE PRESENTATION.pptx

Age peds

1. PEDIATRICS CASE PRESENTATION - C DIVYA

2. CASESHEET NAME : Ananya AGE : 4 years GENDER : Female ADDRESS : Porur INFORMANT : Mother REL IABILITY : Good CHIEF PRESENTING COMPLAINTS : Loose stools and vomiting for the past 2 days.

3. HISTORY OF PRESENTING ILLNESS The baby was apparently normal 2 days back, after which she developed loose stools which was sudden in onset, 4 -6 episodes/day, watery in consistency, foul- smelling, no blood/mucus/worms. No precipitating or relieving factors No H/o drug intake No H/o pain during defecation

4. Vomiting for the past 2 days, 4-5 episodes/ day, after intake of food. Vomitus contained undigested food particles. It was non -projectile, non- bilious, not blood stained. No H/o abdominal p a i n , abdominal distension No H/o Fever No H/o decreased urine output No H/o convulsions H / o excessive thirst H/o recent travel

5. PAST HISTORY No similar episodes in the past No H/o radiation No H/o drug intake No H/o allergy No H/o TB, asthma, jaundice, measles

6. ANTENATAL HISTORY 1 st born child out of a non- consangui neous marriage Mother had a spontaneous conception. She was registered and immunised All 3 trimesters were uneventful.

7. BIRTH HISTORY It was term, institutional, normal vaginal delivery The baby cried immediately after birth, breastfed after 1 hr. Birth weight - 3 kg No NICU admission

8. NEONATAL HISTORY Breast feeding initiated after 1hr of delivery Exclusively breastfed upto 6 m onths of age. No NICU admission DEVELOPMENTAL HISTORY No delay in milestones

9. IMMUNISATION HISTORY Fully immunised till date as per National Immunisation Schedule. FAMILY HISTORY No similar complaints in the family. SOCIOECONOMIC HISTORY Lower middle class according to Modified Kuppuswamy scale.

10. SUMMARY A 4 year old girl c h i l d , normal term delivery, belonging to lower middle class as per modified kuppuswamy scale, achieved all developmental milestones upto age, fully immunised, giving H/o of travel , H / o e xcessive thirst has presented with diarrhoea and vomiting for the past 2 days.

11. GENERAL EXAMINATION Consent was obtained and the child examined. Child appears r e s t l e s s No pallor, no icterus, cyanosis,clubbing, pedal edema, generalised lymphadenopathy E y e s - s u n k e n , t e a r s - a b s e n t M o u t h & tongue - d r y VITAL SIGNS RR- 30 breaths/min Pulse rate - 90 beats/min, regular in rhythm, character and volume with no radio radial or radio femoral delay. BP: 90/ 60 mmHg, measured in right brachial artery in sitting position. Temperature: Afebrile

12. ANTHROPOMETRY Weight – 11 kg Height – 93 cm Ht for age < - 2 SD , stunted Wt for age < - 2 SD , Underweight Wt for height < - 2 SD , Moderate acute malnutrition

13. HEAD TO FOOT EXAMINATION Head size and shape normal Face – normal Ears,nose – Normal Eyes – a p p e a r s u n k e n a n d d r y Oral cavity lips and mouth – appear dry Neck – normal Skin turgor – goes back in 2 sec Chest, spine, pa l m s , l i m b s - n o r m a l E x t e r n a l g e n i t a l i a - n o r m a l

14. S Y S T E M I C E X A MINATION A B D O M I N A L E X A MINATION I N S P E C TION N o t d i s t e n d e d , a l l q u a d r a n t s m o v e e q u a l l y w i t h r e s p i r a tion Flanks a r e f r e e Her n i a l o r i f i c e s n o r m a l U m b i l i c u s n o r m a l i n m i d l i n e N o e n g o r g e d v e i n s , s c a r s , s i n u s e s P A L P A T I O N N o t w a r m , s o f t , n o tenderness N o p a l p a b l e s p l e e n , l i v e r o r o t h e r p a l p a b l e m a s s e s PERCUSSION - L i v e r s p a n n o r m a l A U S C U L T A T I O N - B o w e l s o u n d s a r e h e a r d

15. O T H E R S Y S T E M S R E S P I R AT O R Y S Y S T EM Normal ve s i c ular b r e a t h sounds h e a r d C A R D I O V A S C U L A R S Y S T E M S 1 a n d S 2 s o u n d s h e a r d , n o murmurs C E N T R A L N E R V O U S SYSTEM N o f o c a l n e u r o l o g i c d e f i c i t

16. S U M M A R Y A 4 year old girl c h i l d , normal term delivery, belonging to lower middle class as per modified kuppuswamy scale, achieved all developmental milestones upto age, fully immunised, giving H/o of travel , H / o e xcessive thirst has presented with diarrhoea and vomiting for the past 2 days. O / E s h e w a s m o d e r a t e ly m a l n o u r i s h e d , w i t h s i g n s o f s o m e d e h y d r a t i o n .

17. P R O V I S IONAL D I A G N OSIS C a s e o f acute gastroenteritis p r o b a b l y o f v i r a l e t i o l o g y , w i t h s i g n s o f m i l d d e h y dration .

18. M A N A G E M E N T I N V E S T I G A T I O N S Stool e x a m i n a t i o n M a c r o s c o p i c - c o l o u r , c o n s i s t e n c y , p r e s e n c e o f m u c o u s o r b l o o d . M i c r o s c o p i c - p u s c e l l / leukocyte count ( > 1 c e l l s / H P F ) , O v a , Cysts, Trophozoites, Leucocytes Hanging drop for V. cholerae Blood tests - CBC, PBF Serum Electrolytes BUN and Creatinin e Culture and sensitivity Urine - R/M, Culture may be required

19. T R E A T M E N T Treatment of Dehydration - P l a n B treatment o f diarrhoea w i t h s o m e d e hydration W H O : L o w o s m o l a r i t y O R S g i v e n - 7 5 m l / k g o v e r 4 h r s , r e a s s e s e d a f t e r 4 h r s . 1 - 2 m l / k g - o n g o i n g l o s s e s D i e t a r y management - c o n t i n u e r e g u l a r f e e d i n g w i t h e n e r g y d e n s e f o o d s w i t h l e a s t b u l k . E g - R i c e , k h i c h r i , p u l s e s , c u r d , y o g u r t , e t c . e n r i c h e d with f a t s , o i l , s u g a r . Recommend e d f l u i d s - l e m o n w a t e r , r i c e w a t e r , s o u p s , d a l w a t e r , c o c o n u t w a t e r , e t c . F o o d s t o b e a v o i d e d - f r u i t j u i c e s , j u n k f o o d s , s p i c y f o o d s , carbonated d r i n k s , t e a , c o f f e e . Z inc therapy - 1 m g / d a y i n < 6 m o n t h s , 2 m g / d a y i n > 6 m o n ths f o r 2 w e e k s . Antimicrobials - A n t i b i o tics h a v e n o r o l e i n a c u t e d i a rrhoea s i n c e i t s mostly v i r a l e t i o l o g y .

20. P R E V E N T I O N Improvement of Nutritional status. Safe drinking Water Supply & i m p r o v e d s a n i t a r y f a c i l i ties in the community , g o o d h y g i e n e . Exclusive Breast feeding till 6 Months. Easy availability of ORS sachets. H e a l t h e d u c a t i o n - Hand washing before handling food , e a r l y s i g n s & symptoms o f d i arrhoea , d e t a i l s a b o u t p r o p e r u s e o f O R S . Vaccines : Rotavirus vaccine Cholera Vaccine Typhoid Vaccine ETEC Vaccine

21. T H A N K Y O U ! !