From the Research
The workup for a 10-month-old female with decreased oral intake in the emergency department should begin with a thorough history and physical examination, focusing on signs of dehydration and potential underlying causes, as recommended by the most recent and highest quality study 1. The initial assessment should include duration of symptoms, presence of fever, vomiting, diarrhea, respiratory symptoms, and last wet diaper.
- Vital signs including temperature, heart rate, respiratory rate, blood pressure, and oxygen saturation are essential.
- Initial laboratory tests should include a complete blood count, basic metabolic panel, urinalysis, and urine culture.
- Consider additional tests based on clinical suspicion:
- Chest X-ray if respiratory symptoms are present
- Rapid viral testing during appropriate seasons
- Stool studies if diarrhea is present
- Assess hydration status and consider a trial of oral rehydration therapy with Pedialyte if mild dehydration is present, as supported by 2.
- For moderate to severe dehydration, IV fluid resuscitation with normal saline or lactated Ringer's at 20 mL/kg boluses may be necessary. The underlying cause of decreased oral intake in infants is often infectious (viral gastroenteritis, URI, otitis media, UTI), but can also include more serious conditions like meningitis, sepsis, or metabolic disorders, making a systematic approach to diagnosis crucial, as highlighted in 3. Although a case of Lemierre syndrome was reported in a 10-month-old female infant with decreased oral intake 4, this is a rare condition and should not be the primary focus of the initial workup. Instead, the most recent and highest quality study 1 provides guidance on the importance of assessing hydration status and managing fluid and electrolyte deficits in hospitalized patients.