Approach to vomiting (pediatrics) Quiz: Ace Your Exams
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A 4-year-old girl is brought to the emergency department for evaluation of 12 hours of vomiting and diarrhea. She has had three episodes of non-bilious, non-bloody vomiting and six watery stools. The child has been unable to tolerate fluids and has not urinated for 8 hours. She recently attended a birthday party a few days ago, and several children have since developed similar symptoms. Medical history is unremarkable, and the patient takes no medication. Temperature is 37.8°C (100.0°F), blood pressure is 78/40 mmHg, heart rate is 140 beats per minute, respiratory rate is 22 breaths per minute, and oxygen saturation is 98% on room air. The child appears uncomfortable. Mucous membranes are dry, capillary refill time is 3 seconds, and skin turgor is reduced. Abdominal examination reveals mild diffuse tenderness without rebound or guarding. Stool is watery without visible blood or mucus. Laboratory results are shown in the table below. Which of the following is the best next step in management?
| Laboratory Test | Result |
| Serum sodium | 134 mEq/L |
| Serum potassium | 3.2 mEq/L |
| Serum bicarbonate | 17 mEq/L |
| Blood urea nitrogen | 22 mg/dL |
| Creatinine | 0.8 mg/dL |
| Glucose | 90 mg/dL |
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