Friday, February 17, 2012

Pediatric consult

Any of my medical friends want to weigh in on this? (And sorry about the poor history- it is almost impossible to get straight answers and accurate facts.) 

4 month old male
Chief complaint: Vomiting several times a day, only stools every few days, more than 1 pound weight loss over last week (estimated by fellow missionary who saw him last week.)  Generalized weakness and lethargy. 
Physical assessment: 7.5 kg, normally developed male. No indications of pain or fever. Abd soft and non-tender. Bowel sounds absent. A few indications of slight dehydration. 
History; Birth by C-section. Sepsis (? highly unlikely as I've yet to meet a neonate here who survives sepsis in that hospital but I guess it is possible) immediately after birth possibly due to infected cord.  Per pt’s mother he had normal bowel movements for a short time after birth but not since. Often only stools ever few days. Fevers off and on (per pt’s mother but this may be untrue as mothers here often tell me that there is a fever when there is not. When it is 112 degrees babies are just warm.) Pt has been under treatment for malaria twice but tested negative for me. (It’s common to be treated when not infected and it isn’t malaria season so is pretty unlikely he has ever had.)  Also has been on 6 different antibiotics since birth but none given in correct doses for correct amounts of time and not for correct reasons. 
For me the weight loss and vomiting is concerning. I’ve counseled the mother to ONLY breast feed at this time as she was supplementing with cow’s milk and broth. She should let him suckle every few hours and drink more herself. He is not refusing to eat but often only takes a little then vomits. I’ve also encouraged them to write down (date and time) of stools, feedings, fevers and vomiting. I’ll try to take his weight daily and see how significant the loss actually is and try to get them to get a stool sample for me. Over the past two days I've seen no fevers but he is fussy. 

At this point any suggestions or ideas? Am I being overly concerned about nothing?


Cindy said...

Peg suggests possibly Pyloric stenosis,
?check for worms, or possible partial obstructions.
If bloody or current jelly stools check for intussception

Patrick Jude Gable Hodack said...

Not that I'm a peds person, but it sounds like something with the gut... If he won't eat and vomits and has no bowel sounds... I agree with Cindy (Peg)- what belly bugs do you see? Is there such a thing as pedialyte there? I don't know treatment but I think it's a gut thing. Sorry, not too helpful.