This educational guide provides a much-needed subspeciality-specific learning resource for pediatric hospital medicine. Featuring 50 of the most commonly presenting topics encountered by pediatric hospitalists, this book brings readers into the morning meeting and walks them through patient presentation, diagnosis, treatment, and resolution, providing realistic examples in an engaging case-based format. Available for purchase at https://shop.aap.org/pediatric-hospital-medicine-a-case-based-educational-guide-paperback/
Case 8: Austin, an 8-Month-Old Boy with Fever and Vomiting
"Austin, an 8-Month-Old Boy with Fever and Vomiting", Pediatric Hospital Medicine: A Case-Based Educational Guide, American Academy of Pediatrics, Melissa G. Cossey, MD, FAAP, Lauren K. Gambill, MD, MPA, FAAP
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Prior to morning rounds, you are preparing to see a new patient named Austin, an 8-month-old boy with no significant medical history who was admitted yesterday afternoon after presenting to the emergency department (ED) with fever and vomiting for 2 days. Austin had further vomiting after an oral challenge in the ED, and thus he was hospitalized for supportive care. His admitting diagnosis was mild to moderate dehydration and oliguria from suspected acute gastroenteritis (AGE).
In the ED, a blood culture was drawn, a peripheral intravenous (IV) line was placed, and Austin was given a 20 mL/kg bolus of normal saline. Overnight, he received maintenance IV fluids, ondansetron, and acetaminophen for his symptoms. In reviewing his medical record, you note that his vomiting has resolved, he has not had any bowel movements documented, and his fevers have persisted, with a maximum temperature of 39.6 °C (103.3 °F). His urine output overnight is documented as 0.8 mL/kg/h. Given his lack of diarrhea and worsening fevers, you are concerned that Austin’s prior diagnosis of AGE may be incorrect.