PATIENT/HX SOAP/LABS DRUGS DISCUSSION

624 G.A. 9M/F ASSESSMENT Racecadotril AGE Hallmark: Increased stool frequency (3 or more times in 24 hours)
Acute Gastroenteritis; Pediatric Reduces hypersecretion of water and with alteration of stool consistency. Usually lasting for 7 days but not
PNEUMONIA; CHRONIC DIARRHEA; MILD Community-Acquired Pneumonia electrolytes into the intestinal lumen by more than 14 days
DEHYDRATION-CORRECTED preventing the degradation of endogenous
PLAN opioids (enkephalin)
Chief Complaint: Diarrhea for 12 days ● Secure consent for admission and
management An oral enkephalinase inhibitor for use in the
History of Present Illness: ● Hook to D5LR to run at 66 mL/hour for treatment of acute diarrhea
Twelve days prior to admission, the patient consulted at 6 hours due 9PM
a private clinic due to a dry cough and 8 episodes of DIET Hypersensitivity
watery yellow stool bristol type 7. No associated ● Diet for age, lactose free milk Headache, drowsiness, fever, nausea and
symptoms such as vomiting and fever. Patient was DIAGNOSTICS vomiting
prescribed with Zinc sulfate drops 25 mg/ml 1 ml once a ● Complete blood count with platelet
day, Metronidazole 125 mg/5mL 0.5mL 3 times a day for count (done outside) Erceflora
5 days, which the patient completed, and sodalite mixed ● Fecalysis Contributes to the recovery of the intestinal
with 7 mL of water after every loose bowel episode. ● Urinalysis microbial flora altered during the course of
● Chest x-ray AP lateral (done outside) microbial disorders of diverse origin.
During the interim, there was noted decrease frequency ● RT-PCR
of loose watery yellow stools bristol type 7 but could ● Sodium, Potassium, Chloride (done Acute diarrhea with duration of less than or
not be quantified. Still persistence of dry cough. outside) equal 14 days due to infection, drugs, or
● C-reactive protein poisons.
Three days prior to admission still with episodes of DRUGS Chronic or persistent diarrhea with duration of
loose watery yellow stools bristol type 7 and dry ● Racecadotril 10 mg, give 1 sachet, mix greater than 14 days.
cough. The patient was noted to be playful with a into 20 ml water three times a day
decrease in appetite. Patient sought consultation and ● Bacillus clausii vial (Erceflora), give 1 Hypersensitivity. Not for use in
was given ORS. vial, two times a day immunocompromised patients
● PNSS 2 ml nebulizer every 6 hours Immune system disorders, hypersensitivity
Two days prior to admission the patient had 3 episodes reactions (rashes, urticaria, angioedema)
of loose watery yellow stools bristol type 7. Patient DISPOSITION
still had a dry cough with decreased activity from her ● Weigh patient now then daily and PNSS Nebulizer
usual activity of walking around in her walker to record Induces an osmotic flow of water into the
preferring to be carried. Patient also had a decreased ● Monitor vital signs every 4 hours and mucus layer, thus rehydrating the airway
appetite consuming only 1 bottle of milk, thus sought record surface liquid and improving mucociliary
consultation at a private hospital where the chest x-ray ● Monitor intake and output every shift clearance, as well as reducing airway edema by
and CBC were requested. The patient was diagnosed and record absorbing water from the mucosa and
with pneumonia and was given the following submucosa.
medications: Erceflora, 1 vial two times a day and CXR: Consider Bilateral Interstitial Pneumonic
Racecadotril 10 mg/sachet, 1 sachet, mixed into water Process To moisten or loosen thickened mucus
three times a day. The patient was advised for
admission, however, due to the preference of the patient Hgb: low (100) Patients with unstable and increased blood
they opted to transfer to our institution. Hct: low (0.31) pressure and individuals with cardiac irritability.
RBC: low (3.67)
Few hours prior to admission, the patient who came to MCHC: low (31.8) Hypersensitivity reactions (hives, difficulty of
our Emergency Room was irritable and had 4 WBC: low (5.11) breathing, swelling of face, lips, tongue, or
episodes of loose watery yellow stools. Patient still N: low (0.03) throat.
has dry coughs and was subsequently admitted. L: high (0.78)
M: high (0.18)
Family History:. Risk factors:
 ● Mother: 36 years old, banker, with productive - Age Predilection
cough; - Infancy: Rotavirus & NTS
● Father: 37 years old, BPO, apparently well - 1-4 years old: Endemic Shigellosis
● With 1 sister, 10 years old, who also has cough
- Infants, young children, adolescents & young adults:
taking co-amoxiclav
● Campylobacter & Cryptosporidium
Nutritional History: - Immunodeficiency
Patient started with breastfed mixed with formula milk - Malnutrition
(S-26 gold) until 4 months old. The patient was then - Lack of exclusive breastfeeding
shifted to S-26 hypoallergenic due to difficulty in
defecating at 5 months old. Solid foods were introduced Gastroenteritis is inflammation of the stomach, small intestine, or
to her at 6 months like mashed potato and cerelac. large intestine, leading to a combination of abdominal pain, cramping,
nausea, vomiting, and diarrhea. Acute gastroenteritis usually lasts fewer
than 14 days. This is in contrast to persistent gastroenteritis, which lasts
between 14 and 30 days, and chronic gastroenteritis, which lasts more
than 30 days. Gastroenteritis denotes infections of the gastrointestinal (GI)
tract caused by bacterial, viral, or parasitic pathogens. Many of these
infections are foodborne illnesses. Viral causes of acute gastroenteritis are
dominated by rotavirus and norovirus. Rotavirus causes a particularly
severe dehydrating gastroenteritis that affects young children. The severity
of the infection is made worse by malnourishment, making rotavirus a
significant cause of mortality in children worldwide. The introduction of the
rotavirus vaccine has been effective at reducing rotavirus gastroenteritis.

The patient presented with loose stools for 12 days.

MANAGEMENT:
PNEUMONIA
Pneumonia is a form of acute respiratory infection that affects the lung.
When an individual has pneumonia, the alveoli are filled with pus and fluid,
which makes breathing painful and limits oxygen intake. Pneumonia is the
single most common cause of death in children, estimated at 1.2 million
every year. This represents 18% of all deaths below 5 years of age
worldwide. The large majority of deaths occur in low to middle income
countries. Among countries in Southeast Asia, the Philippines has a
relatively high age-standardized death rate of 126 per 100,000 population
as of 2017. Pneumonia is the third leading cause of death in the country
across all ages, next only to cardiac diseases and cancer. In Filipino
children below 5 years of age, it is the most common cause of death
accounting for about 14% of all causes of mortality.
 According to WHO, while most healthy children can fight the
infection with their natural defenses, children whose immune systems are
compromised are at higher risk of developing pneumonia. A child's
immune system may be weakened by malnutrition or undernourishment,
especially in infants who are not exclusively breastfed. Pre-existing
illnesses, such as symptomatic HIV infections and measles, and asthma,
can also increase a child's risk of contracting pneumonia. The following
environmental factors also increase a child's susceptibility to pneumonia:
urbanization, indoor air pollution caused by cooking and heating with
biomass fuels (such as wood or dung), living in crowded homes, parental
smoking. And lastly, lack of immunization. Cough, fever, chest pain,
shortness of breath and difficulty breathing remains the classic symptoms
of pneumonia.