9 month old with one day of lethargy
kulleni
A seven month old male infant is brought to the Emergency Room in the mid-afternoon with a chief complaint of lethargy. He had been entirely healthy until this morning when he seemed a bit fussier than usual. He ate his breakfast well but he vomited immediately thereafter. He had two additional episodes of forceful vomiting after which he became quite somnolent and he subsequently fell asleep. When mother attempted to arouse him an hour later, he would not awaken. She immediately brought him to the Emergency Room.
On physical exam, he is an quite lethargic and somewhat fussy but very well-grown and in no distress. He is afebrile and his other vital signs are normal with the exception of his blood pressure which is 122/94 in his right arm. His HEENT, chest, and cardiovascular examinations are all entirely normal. He has brisk and symmetrical distal pulses. His abdomen is mildly protuberant and it seems slightly tender but there is no organomegaly nor are there any palpable masses.
While starting an intravenous line, blood is obtained for dextrostick(c), serum electrolytes, liver enzyme tests, complete blood count, and blood culture. His electrolytes are all entirely normal including a glucose of 70 mg/dl. Liver enzymes are also normal. Serum WBC is 11,000 and HCT is 34% A lumbar punture is performed. and the fluid is clear and colorless. Microscopic examination demonstrates 0 WBC and 0 RBC. An ECG is also performed and is thought to be normal for age.
While he is still in the Emergency Room, the infant passes a large watery stool which is grossly bloody. Microscopic examination of the stool does not demonstrate any leukocytes. On rectal examination, he has largely empty vault of normal size. The small amount of stool present is grossly bloody.
An abdominal film is performed while he is in the Emergency Room and demonstrates multiple loops of dilated bowel suggestive of a small bowel obstruction.
Interpretation: There are a number of very dilated loops of bowel suggesting an anatomic obstruction. It is unclear whether this represents small and/or large bowel. There is relative paucity of air in the right lower quadrant. There are no bony abnormalities and the spine appears normal.
You consulted with the pediatric surgeons and pediatric radiologist. An air contrast enema is performed., http://www.100md.com
A seven month old male infant is brought to the Emergency Room in the mid-afternoon with a chief complaint of lethargy. He had been entirely healthy until this morning when he seemed a bit fussier than usual. He ate his breakfast well but he vomited immediately thereafter. He had two additional episodes of forceful vomiting after which he became quite somnolent and he subsequently fell asleep. When mother attempted to arouse him an hour later, he would not awaken. She immediately brought him to the Emergency Room.
On physical exam, he is an quite lethargic and somewhat fussy but very well-grown and in no distress. He is afebrile and his other vital signs are normal with the exception of his blood pressure which is 122/94 in his right arm. His HEENT, chest, and cardiovascular examinations are all entirely normal. He has brisk and symmetrical distal pulses. His abdomen is mildly protuberant and it seems slightly tender but there is no organomegaly nor are there any palpable masses.
While starting an intravenous line, blood is obtained for dextrostick(c), serum electrolytes, liver enzyme tests, complete blood count, and blood culture. His electrolytes are all entirely normal including a glucose of 70 mg/dl. Liver enzymes are also normal. Serum WBC is 11,000 and HCT is 34% A lumbar punture is performed. and the fluid is clear and colorless. Microscopic examination demonstrates 0 WBC and 0 RBC. An ECG is also performed and is thought to be normal for age.
While he is still in the Emergency Room, the infant passes a large watery stool which is grossly bloody. Microscopic examination of the stool does not demonstrate any leukocytes. On rectal examination, he has largely empty vault of normal size. The small amount of stool present is grossly bloody.
An abdominal film is performed while he is in the Emergency Room and demonstrates multiple loops of dilated bowel suggestive of a small bowel obstruction.
Interpretation: There are a number of very dilated loops of bowel suggesting an anatomic obstruction. It is unclear whether this represents small and/or large bowel. There is relative paucity of air in the right lower quadrant. There are no bony abnormalities and the spine appears normal.
You consulted with the pediatric surgeons and pediatric radiologist. An air contrast enema is performed., http://www.100md.com