The study was performed on a3-year-old male came to the inpatient floor becauseof intractable emesis of non-bilious fluid and stomach contents and some watery diarrhea for 36 hours after exposure to a particularly virulent form gastroenteritis at his daycare. He was not tolerating any oral or gastrotube feedings and had not urinated for 10 hours. He also had a 10-15 second generalized tonic-clonic seizure in the emergency room that was similar to his usual seizures that generally occurred 2-3 times/week. He also had a bout of watery diarrhea in the emergency room. The past medical history showed him known to have microcephaly with some areas of polymicrogyri diagnosed as an infant, and seizures that were reasonably well-controlled on phenytoin.
The pertinent physical examshowed a male in mild distress with dry mucous membranes. His weight was down 1040 grams from a recent clinic visit. His heart rate was 112 beats/minute and respirations were 26/minute. His blood pressure was 76/54. His abdomen was very mildly tender diffusely without guarding or rebound tenderness. His gastric tube was in place. There was no organomegaly and his bowel sounds were hyperactive. Neurologically he was semi-noncommunicative. His cranial nerves were normal, DTRs were slightly hyperreflexic and his tone was good. This was his normal neurological examination and the rest of his examination was normal. The work-up showed a normal abdominal radiograph, electrolytes and urinalysis were consistent with mild dehydration, and his complete blood count was normal. His phenytoin level was therapeutic. The diagnosis of gastroenteritis and dehydration was made. In the emergency room he was given on dansteron and intravenous fluids but he still could not tolerate fluids and was admitted. Over the next 24 hours he began to tolerate fluids. He had another similar seizure but again had therapeutic levels and his parents and neurologist were comfortable monitoring him at home and potentially making medication changes by telephone.