Clinical feature | Potential significance |
Historical features | |
Fever:
|
|
Gross blood or mucus in stool |
|
Bilious vomiting |
|
Projectile vomiting |
|
Persistent diarrhea (>7 days) |
|
Persistent, recurrent, or isolated vomiting |
|
Increased urine output |
|
Altered consciousness, seizures, focal neurologic abnormalities |
|
History of trauma |
|
Weight loss and multisystem involvement |
|
Recent antibiotic exposure |
|
International travel |
|
Exposures: unsafe foods (eg, raw/undercooked meats, eggs, shellfish, unpasteurized milk or juice), farm animals, petting zoo, reptiles, pets with diarrhea, untreated surface water |
|
Examination | |
Moderate to severe dehydration in a child >2 years |
|
Bulging fontanelle |
|
Bulging tympanic membrane |
|
Hypotension disproportionate to apparent illness and/or hyponatremia with hyperkalemia |
|
Tachypnea, retractions, crackles, decreased breath sounds |
|
Marked abdominal distention, peritoneal signs, absent bowel sounds or increased high-pitched bowel sounds ("borborygmi") |
|
Focal abdominal tenderness |
|
Abdominal mass |
|
Petechiae, purpura, bruising |
|
Jaundice |
|
Signs of trauma |
|
Increased muscle tone, hyperreflexia |
|
Laboratory findings (if performed) | |
Abnormal CBC |
|
Elevated serum C-reactive protein, procalcitonin |
|
Fecal leukocytes, fecal lactoferrin, fecal calprotectin |
|
Eosinophils on fecal smear |
|
Persistent watery diarrhea |
|
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