4yr female child, complaining of only vomiting for 4-5times in a day for 2days,how to approach??

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Rule out the cause one by one from history and clinical examination ..... 1. Gastritis/GERD : Associated with pain upper mid abdomen and heart burn. 2. Lactose intolerance : Rule out association with milk or milk product, Wheat product etc. 3. Meningitis : check for fever, r/o neck rigidity. If suspected then advice for RE blood, CSF study. 4. Intussuception/Intestinal obstruction : Severe pain abdomen, abdominal swelling, inability to pass stool and flatus, absent bowel sound or rumbling bowel sound. If suspected advice Urgent straight x-ray abdomen. 5. Sepsis/SIRS : Check for temperature, vitals, r/o systemic infections like uti & pulmonary infections. Advice CBC, CRP, LDH, Urine RE, Chest Xray. 6. UTI : Fever, pain lower mid abdomen & tenderness, frequency of urination. Advice Urine RE / CS. 7. RTI/Pneumonia : fever, chest pain, crepts in chest, increased respiratory rate. Advice Chest Xray, Blood RE. 8. Hepatitis : Yellowish urination, fever, right upper abdomen pain or tenderness, hepatomegaly. Advice Hepatitis viral panel (specially A,E), RE blood, LFT, USG W/A. 9. Constipation : Difficulty in passing stool, hard stool. 10. Appendicitis : Periumbilical or right lower abdomen pain, fever. Advice USG/CT abdomen, RE blood. 11. Worm infestation : Pain at amoebic point, perianal itching, pain abdomen, bloody diarrhoea may be present. Investigations to be advised on the basis of clinical history and examination findings.

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maintaining hydration is of utmost importance with antiemetics . bilious or non bilious . associated symptoms like fever loose stool pain abdomen . urine output . all these things matters . give syp ondem 5 ml sos for vomiting as for now . can add syp taxim o forte 3 ml twice daily if u r suspecting infective etiology

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Observe for high colored urine to r/o viral hepatitis, ??headache, fever, neck rigidity?? Meingitis ??worm infestation ??Gastritis, Rx tab.Lansprizole-15 mg

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Find out cause, examine for urine and stool Also treat other causes like overeating etc Give antiemetic , and digestive drugs

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Ask for CBC ESR RE URINE USG of whole ABDOMEN LFT RFT further treat symptomatic

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Vomiting cause dehydration to child Try to find cause behind this Most probable its dyspepsia Or may be infective etiology Meanwhile you start Syrup Ondan 3 ml tds Syrup zifi 5 ml bd Ors redimix solution frequently Review next day

Avoid milk & fruits... Antiemetic & PPI

Antiemetic and digestive drug

R/O viral hepatitis, meingitis(if neckk rigidity +ve,) Rx tab.lansprazol- 15 mg Od Tab.vomikind 1bd
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