Important aspects of the examination of a child with acute gastroenteritis

Clinical finding	Potential significance
Growth parameters
Body weight	Used to determine degree of dehydration and response to fluid repletion
Growth retardation	Chronic underlying condition (eg, gastrointestinal disease, immune deficiency)
Vital signs
Fever: ≥38°C (100.4°F) in patient <3 months ≥39°C (102.2°F) in patient ≥3 months	Temperature elevation tends to be higher in extraintestinal infection or bacterial gastroenteritis (particularly if >40°C [104°F])
Rapid, weak, or absent pulse	Dehydration
Decreased blood pressure	Dehydration, shock, sepsis
Hypotension disproportionate to apparent illness	Adrenal crisis
HEENT
Sunken anterior fontanelle, sunken eyes	Moderate to severe dehydration
Bulging anterior fontanelle	Increased intracranial pressure
Scleral icterus	HUS, viral hepatitis
Bulging tympanic membrane	Acute otitis media
Tacky, dry, or parched mucous membranes	Dehydration
Fruity/ketotic breath	Diabetic ketoacidosis
Exudative tonsillitis/palatal petechiae	Streptococcal pharyngitis
Neck
Neck stiffness, nuchal rigidity, other meningeal signs	Meningitis
Chest
Deep respirations	Moderate to severe dehydration, acidosis
Tachypnea, crackles, decreased breath sounds	Pneumonia
Abdomen
Severe, localized pain, rebound tenderness, marked abdominal distension	Acute abdomen (eg, appendicitis, bowel obstruction, toxic megacolon)
Hypoactive/absent bowel sounds	Hypokalemia
Flank pain or suprapubic tenderness	UTI
Abdominal mass	"Olive" at lateral edge of rectus abdominus in RUQ: pyloric stenosis "Sausage-shaped" right-sided mass: intussusception
Skin
Cool, mottled, poor capillary refill, decreased turgor	Moderate to severe dehydration, sepsis
Nonblanching lesions (petechiae, purpura, bruises)	HUS, trauma (intracranial, intra-abdominal)
Jaundice	HUS, viral hepatitis
Neurologic
Altered consciousness or focal neurologic abnormalities	Toxic ingestion, diabetic ketoacidosis, CNS mass, or inborn error of metabolism

HEENT: head, eyes, ears, nose, throat; HUS: hemolytic uremic syndrome; UTI: urinary tract infections; RUQ: right upper quadrant; CNS: central nervous system.

Graphic 103393 Version 3.0

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Important aspects of the examination of a child with acute gastroenteritis