A 6 month old male patient presents to your clinic with his mother. The mother’s chief complaint is that the baby has had a fever and diarrhea for several days and is not nursing as much as usual. The infant is quiet and warm, lung sounds are clear, heart sounds normal. No medical history, born healthy at 39 weeks 5 days via uncomplicated vaginal delivery, he is exclusively breast fed and is up-to-date on his vaccinations.

What additional signs/symptoms would alert you that this infant may need to be transferred to the ER?

Additional symptoms that would alert the clinician the infant should be taken to the emergency room include: abnormal respiratory pattern, tachycardia, little or no urine output, irritability, lethargy, sunken eyes, sunken fontanelles, decreased tears, dry mucous membranes, skin tenting, delayed capillary refill, cool, pale skin, and weak pulse.

What are your top 3 differential diagnoses?

Viral gastroenteritis

Bacterial gastroenteritis

Parasitic gastroenteritis

Gastroenteritis generally presents an acute onset of nausea, vomiting, diarrhea, dehydration signs, fever, chills, myalgia, and weight loss (Fenstermacher & Hudson, 2016). In the United States, 75-90 percent of cases of acute gastroenteritis are due to rotavirus, 10-20 present of cases are due to Escherichia coli, and under 5 percent of cases are due to parasites such as Giardia intestinalis and Cryptosporidium (Noguera, 2014). In pediatric patients, dehydration can occur quickly and the degree of dehydration is categorized by none, mild to moderate, and serve. Small, frequent feedings are recommending to increase PO intake and reduce dehydration. If the patient is not sent to the emergency department for management of symptoms and rehydration, a detailed plan of care and specific signs and symptoms to watch for need to be given to the patient’s parents that would require a return back to the clinic or emergency department.


Fenstermacher, K., & Hudson, B. T. (2016). Practice guidelines for family nurse practitioners. Philadelphia, PA: Elsevier.

Noguera, T., Wotring, R., Melville, C. R., Hargraves, K., Kumm, J., & Morton, J. M. (2014). Resolution of acute gastroenteritis symptoms in children and adults treated with a novel polyphenol-based prebiotic. World journal of gastroenterology, 20(34), 12301-7.


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