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A
lady on the phone says that her 8-year-old daughter is having diarrhea.
She herself is also having diarrhea. Her daughter had another attack of diarrhea
6 month back. Take history and give relevant advice, as she is very
anxious. |
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Answer
plan:
1.
Introduction & rapport questions (age sex important)
2. About diarrhea
· Duration, frequency
· Stool consistency
· Blood/mucus/pus
3. Other s/s
· Fever/rash/bleeding/vomiting
· Feeding
4. Assess dehydration
5. Advice
· A&E/GP
· ORS
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Answer:
Hello, Dr. xxx
speaking. How can I help you Madam.
(The mother tells that her child is having diarrhea)
How old is she? Is it a boy or a girl?When did the diarrhoea start? How
frequently is she passing stool?
What does the stool like?
Is there any blood or mucus with the stool? Is the blood mixed or around
it?Is there fever?
Has she vomited? What did she vomit? (Color-blood/bile)
Does she have rash any where in the body?
Is there any bleeding?
How are you feeding her? Has there been similar episode before? Can you
give a bit detail?
Is there any one in the family also having diarrhea? If yes food,
travel?How does she look now?
Do the eyes look sunken?
Is she drowsy?
Can she take the feeding? Does she take it eagerly?
How is the soft spot( Ant. Frontanalle)
Have you noticed any funny colour around her lips?
How is the breathing?I think it sounds as if it might be urgent enough
to bring your daughter to A&E
Or,
I think your daughter is having………. You should give your daughter
ORS. One sachet has to be dissolved in 7 ounce of water. You can
continue breast-feeding and may consider stopping bottle-feeding. If
things do not improve I would suggest you get her to see GP. |
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Note:
Acute:
Duration <2 wks: almost always infection/drugs/introduction of new
food
Acute haematochezia: bacteria/amoeba
Rash & thrombocytopenia: HUS
Chronic
Rule out Celiac disease/IBD
Age
<2: rule out cogenital problem /CF/ milk or soy allergy
Preschool: can be chronic non-specific diarrhea (2-10 stools/day and no
associated feature)
Older: lactose intolerance
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