Approach to shock (pediatrics) Quiz: Ace Your Exams
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A 13-month-old infant girl is brought to the emergency department by her parents because she has been vomiting and having diarrhea for three days. Parents report she has not been drinking or eating well for the past few days, and for the past 24 hours, she has not had a wet diaper. She has not had a fever, rash, or cough. Past medical and surgical histories are non-contributory. Temperature is 37.5°C (99.5°F), pulse is 180/min, respirations are 45/min, blood pressure is 60/35 mmHg, and oxygen saturation is 97% on room air. On physical exam, the infant appears lethargic and does not respond to verbal or tactile stimulation. Peripheral pulses are weak, and the extremities are cool. Capillary refill time (CRT) is seven seconds, and mucous membranes appear dry. Breath sounds are equal bilaterally with minimal subcostal retractions. Cardiac and abdominal exams are unremarkable. Laboratory results are shown below. Which of the following is the best next step in management?
| Laboratory value | Results |
| Hemoglobin | 14.5 g/dL |
| White blood cells | 13,000 /μL |
| Platelets | 140,000/μL |
| pH | 7.12 |
| pCo2 | 40 mmHg |
| Sodium bicarbonate | 10 mEq/L |
| Blood urea nitrogen (BUN) | 28 mg/dL |
| Creatinine | 1.2 mg/dL |
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