Infant with Vomiting and Diarrhea Mariam Alosfoor

Objectives

Most probable diagnosis? Based on which information from the case study?

Which diagnostic tests would you perform?

What information do you provide these parents about therapy and prognosis?

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Case Analysis

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Dehydration• Vomiting/diarrhea for 1 week

• Watery diarrhea up to 10 times/day

• Fontanel normal level

• RR 35/min• HR 120/min• Pale, dry skin, flacking at cheeks.

FTT• Weight = 4.350 Kg

• 80 grams gain in 2 weeks

• Sunken abdomen

Disease• 7 weeks infant

• Vomiting milk colored

• Bottle feeding 2 weeks ago

• Does not finish his bottle

• Agitated + cried more

• Temp. 36.9• No signs of ENT infections

Dehydration

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Failure to Thrive

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DDx of Diarrhea

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Cow’s Milk AllergyFood-Protein-Induced Enterocolitis Syndrome (FPIES)

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Investigations

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Investigations

Blood TestAnemia

Hypoalbuminemia

Eosinophilia

Stool Studie

sOccult blood

WBC

Allergy Tests

Skin prick test

Serum IgE test

Oral Food Challenge

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Oral Food Challenge

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Double Blind Placebo Controlled Food Challenge

Single Blinded food challenge

Open food challenge

Oral Food Challenge

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Therapy and PrognosisWhat would you tell the parents?

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Management Dietary

elimination Exclusive

breastfeeding

Hypoallergenic

formulas

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Hypoallergenic Formula

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Management

Solid food introductio

n

• Start with fruits at age of 4 – 6 months

• Introduce cow’s milk at age of 1 year

Follow Up

• Check patient’s tolerance at age 1 year

• Repeat OFC every 18 months

Prognosis

• Symptoms improve after 3 – 10 days• 70% of patients outgrow it by 1st year• 80% by age of 5

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ons Prognosis Summary

FPIES manifests as vomiting, with diarrhea, leading to dehydration and lethargy in the acute setting, or weight loss and failure to thrive in a chronic form.

The diagnosis of FPIES is based upon the history, constellation of typical clinical symptoms with clinical improvement following withdrawal

Cow's milk and soy FPIES resolve in a majority of patients by age three years.

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References

Anna NW. Food protein-induced enterocolitis syndrome (FPIES). In: UpToDate.

Nelson Essentials of Pediatrics. Philadelphia: W.B. Saunders Co, 2002. Print.

Introduction Diagnosis Investigati

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Any Questions?