What is the appropriate management for an 11-year-old male presenting with fever, fatigue, sore throat, nausea, diarrhea, and vomiting?

Management of an 11-Year-Old Male with Fever, Fatigue, Sore Throat, Nausea, Vomiting, and Diarrhea

Immediate Priority: Assess and Treat Dehydration

The first priority is to assess the child's hydration status and initiate oral rehydration therapy (ORT) with oral rehydration solution (ORS), as fluid and electrolyte replacement takes precedence over all other interventions in children presenting with vomiting and diarrhea. 1

Hydration Assessment

Evaluate for signs of dehydration by checking:

• Skin turgor and mucous membrane moisture 1
• Mental status (drowsiness indicates severe dehydration requiring immediate intervention) 1
• Vital signs including heart rate and blood pressure 1
• Urine output (decreased frequency/volume suggests dehydration) 1
• Body weight if baseline available 1

Dehydration Management Based on Severity

If no dehydration or mild dehydration:

• Initiate ORS at home: 50-100 mL after each loose stool 1
• Continue small amounts of fluid throughout the day rather than large volumes at once 2
• Use glucose-containing beverages (lemonades, fruit juices) or soups rich in electrolytes as alternatives 1

If moderate dehydration (but able to drink):

• Administer ORS at 15 mL/kg body weight/hour if unable to drink adequately 1
• Reassess hydration status after 3-4 hours 1
• Resume feeding as soon as appetite returns—do not delay feeding until diarrhea stops 1

If severe dehydration with warning signs:

• Immediate medical evaluation required if any of the following present: 1
  • Vomiting >24 hours
  • Drowsiness or altered consciousness
  • Signs of respiratory distress
  • Severe dehydration (sunken eyes, very dry mucous membranes, poor skin turgor)

Symptomatic Management

Fever Control

• Use antipyretics (acetaminophen or ibuprofen) for comfort 1
• Never use aspirin in children due to Reye's syndrome risk 1

Nausea and Vomiting Management

• Ondansetron is the preferred antiemetic if vomiting prevents adequate oral intake 3
• Administer as a single dose to facilitate oral rehydration 4
• Do not prescribe multiple days of ondansetron for gastroenteritis as it may increase stool volume 4
• Continue oral rehydration attempts even with ongoing emesis, as most fluid is retained 3

Diarrhea Management

• Do not use antimotility agents (loperamide) in children with fever or if infectious diarrhea suspected 3
• Antimicrobial drugs are contraindicated for routine treatment of uncomplicated watery diarrhea 1

Evaluation for Specific Infections

High Fever (>38.5°C) with Respiratory Symptoms

Given the combination of fever, sore throat, and systemic symptoms during potential influenza season:

• Consider influenza testing if high fever with cough or influenza-like symptoms 1
• Oseltamivir may be indicated if influenza confirmed and patient at risk for complications 1

Bacterial Infection Considerations

Antibiotics are indicated ONLY if: 1

• Dysentery (high fever >38.5°C AND frank blood in stools)
• Severe earache suggesting bacterial otitis media
• Breathing difficulties suggesting bacterial pneumonia
• Laboratory confirmation of bacterial pathogen (Shigella, cholera, Salmonella)

For this 11-year-old with high fever and sore throat plus GI symptoms, evaluate for streptococcal pharyngitis with rapid strep test if throat examination suggests bacterial infection. 1

Nutritional Support

• Resume feeding immediately once the child can tolerate oral intake 1
• Offer small, light meals guided by appetite 1
• Energy-rich, easily digestible foods help maintain nutritional status 1
• Avoid fatty, heavy, spicy foods and caffeine 1
• Consider avoiding lactose-containing foods if diarrhea prolonged 1

Red Flags Requiring Immediate Medical Evaluation

Seek emergency care if any of the following develop: 1

• Signs of severe dehydration (extreme lethargy, sunken eyes, no tears, no urine output)
• Vomiting persisting >24 hours
• High fever >38.5°C with drowsiness
• Breathing difficulties or respiratory distress
• Altered consciousness or seizures
• Frank blood in stools with high fever (dysentery)
• Signs of septicemia (extreme pallor, hypotension)

Common Pitfalls to Avoid

• Do not withhold food waiting for diarrhea to resolve—early feeding speeds recovery 1
• Do not use anti-diarrheal medications in children with fever or suspected infectious cause 3
• Do not prescribe antibiotics empirically without evidence of bacterial infection 1
• Do not give large fluid volumes at once—small frequent amounts are better tolerated 2
• Do not use aspirin for fever control in children 1