From the Guidelines
The most appropriate next step in management for this 7-year-old boy is administration of intravenous fluids (option B). This child presents with fever, abdominal pain, nausea, vomiting, and signs of dehydration, including dry mucous membranes and hypoactive bowel sounds. The presence of fever, tachypnea (28 respirations/min), and auscultatory findings of crackles at the right lung base are also noted, but the primary concern is the patient's hydration status. According to the guidelines for the diagnosis and management of infectious diarrhea 1, administration of intravenous fluids is crucial in managing dehydration, especially in children. The guidelines recommend that ancillary treatment with antimotility, antinausea, or antiemetic agents can be considered once the patient is adequately hydrated 1. In this case, the patient's dehydration and symptoms of nausea and vomiting suggest that intravenous fluids should be administered promptly to prevent further dehydration and electrolyte imbalances. While a chest x-ray (option C) may be necessary to evaluate the patient's respiratory symptoms, the immediate priority is to address the patient's hydration status. The other options, including abdominal ultrasonography (option A), complete blood count (option D), and rapid streptococcal test (option E), may be considered later in the management plan, but they are not the most appropriate next step in this scenario. It is essential to prioritize the patient's hydration status and manage dehydration promptly to prevent complications and improve outcomes 1.
From the Research
Patient Assessment and Management
The patient is a 7-year-old boy presenting with severe diffuse abdominal pain, nausea, vomiting, and fever. He has not eaten since the onset of vomiting and has dry mucous membranes, indicating possible dehydration.
Key Findings and Next Steps
- The patient's symptoms and physical examination suggest dehydration and possible hypovolemia.
- The most appropriate next step in management would be to address the patient's fluid status.
- Administration of intravenous fluids is a common intervention in critically ill patients and can help correct hypovolemia and dehydration 2, 3, 4, 5.
- The choice of intravenous fluid should be guided by the patient's overall clinical picture, including the cause of hypovolemia, cardiovascular state, renal function, and serum osmolality 3.
Recommended Course of Action
- Given the patient's symptoms and physical examination, the most appropriate next step would be to administer intravenous fluids to correct dehydration and hypovolemia.
- The best answer is B) Administration of intravenous fluids.
Rationale for Choice
- The patient's presentation suggests dehydration and possible hypovolemia, which can be addressed with intravenous fluid administration 2, 3, 4, 5.
- While other options, such as abdominal ultrasonography or complete blood count, may be useful in diagnosing the underlying cause of the patient's symptoms, they do not address the immediate need for fluid resuscitation.
- A chest x-ray may be useful in evaluating the patient's respiratory status, but it is not the most appropriate next step in management.
- A rapid streptococcal test may be useful in diagnosing a specific infection, but it is not the most appropriate next step in management of the patient's dehydration and hypovolemia.