This patient is in hypovolemic shock. This is evidenced by the history of unreplaced fluid losses, the physical findings of tachycardia, and dehydration, and systemic signs of hypoperfusion. Children in compensated hypovolemic shock will be tachycardic with normal blood pressure. Left untreated, the patient will become hypotensive (uncompensated hypovolemic shock). Treatment involves immediate fluid resuscitation.
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A 6 year old boy is brought to the emergency room by EMS after having a history of fever and having emesis and diarrhea for the past 3 days. He is otherwise well. Immunizations are up to date for age. Family history reveals that the patient has a sister with asthma. Social history is unremarkable. Upon examination, the patient appears dehydrated. The patient is responsive but lethargic. The neurological,respiratory, and skin exams appears normal. The cardiovascular examination shows normal heart sounds and no murmurs. Eyes are sunken, mucous membranes are dry, pulses are palpable, capillary refill is 4 seconds centrally. The abdominal examination reveals diffuse but non-peritonitic tenderness.
Partially Correct
Granado-Villar D, Cunill-De Sautu, Granados A. Acute Gastroenteritis. Pediatrics in Review 2012;33:487
P Yager and N Noviski. Shock. Pediatrics in Review. 2010;31(8)
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Authors
Dr. Theresa Wu
theresa.wu@ahs.ca
Dr. Susan Bannister
Susan.Bannister@ahs.caReviewers
Dr. Marc Zucker
Zucker@cheo.on.ca