Approach to vomiting (newborn and infant) Quiz: Ace Your Exams
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An 8-month-old boy is brought to the emergency department by his parents for evaluation of fatigue and vomiting. The parents report the patient was in his usual state of health when he awoke in the morning. He ate breakfast, went down for a morning nap, and one hour later woke up from his nap vomiting. He had six episodes of non-bloody, nonbilious emesis in the past two hours before his parents brought him to the emergency department. That morning was the first time the patient ate oatmeal. The patient was born full-term and has no significant past medical history. Temperature is 37.1°C (98.8°F), pulse is 155/min, blood pressure is 85/52 mm Hg, respirations are 32/min, and oxygen saturation is 99% on room air. On physical examination, the anterior fontanelle is open and flat. The patient is lying in his parents’ arms. He appears alert but fatigued. Mucus membranes are moist. No urticaria, facial or lip swelling is present. Cardiopulmonary examination is normal. On abdominal exam there is mild diffuse tenderness but no distension, rebound or guarding and there are normoactive bowel sounds. Which of the following is the best next step in management?
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