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 8 year old boy is brought to the emergency room by EMS after having diarrhea and a history of fever for 5 days. He was previously well. Immunizations are incomplete. Family history reveals that all family members are healthy. Social history reveals that the patient's parents are separated. 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. Mucous membranes are dry, pulses are palpable but weak, capillary refill is 5 seconds centrally and peripherally. 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