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Abstract: Children are susceptible to rotavirus infection, resulting in pediatric diarrheal disease, which typically presents as egg-flake soup-like stools. In this case, the child had an acute onset of diarrhea with egg-flake soup-like stools, and was diagnosed with pediatric diarrheal disease caused by rotavirus infection upon presentation to the hospital. After intravenous infusion and observation treatment, the child’s diarrhea symptoms improved and dehydration was rapidly corrected. After follow-up medication, the child’s diarrhea symptoms completely disappeared and his spirit and appetite returned to normal.
Basic information】Male, 2 years old
Type of disease】Pediatric diarrheal disease
Hospital】Fudan University Hospital of Pediatrics
Date of Consultation】October 2021
Treatment plan】Intravenous rehydration (ribavirin injection + glucose sodium chloride injection, potassium chloride injection) + oral medication (montelukast + Clostridium typhimurium live tablets + oral rehydration salt III)
[Treatment cycle] 1 day of intravenous rehydration + 7 days of oral Clostridium typhimurium tablets and montelukast + 3 days of oral rehydration salt
Treatment effect】Diarrhea improved, dehydration symptoms corrected, stool routine examination normal
I. Initial consultation
The child had indigestible stools after being cold 1 week ago, and the diarrhea symptoms worsened on the second day, manifesting as egg-flake soup-like stools with more water, and the number of times gradually increased to 6-7 times, accompanied by a low fever of 37.8℃, and the child’s milk volume dropped, and the urine volume also decreased. On the same day, he came to our outpatient clinic and was found to have a temperature of 38℃, a slightly soft spirit, a flat fontanelle, few tears when crying, a dry mucous membrane of the mouth and lips, no abnormal heart and lung auscultation, and fair skin elasticity. Outpatient examination of blood routine leukocyte indicators were normal, stool routine examination was not abnormal, but rotavirus test was positive. Based on the characteristics of the child’s diarrhea with symptoms of mild dehydration, combined with the age of onset, season and examination results, the diagnosis of pediatric diarrheal disease caused by rotavirus infection with mild dehydration was made clearly.
II. Treatment history
Since the child was mildly dehydrated when he came to the hospital, he was mentally weak, his mouth and lips were dry, and he did not have many tears when he cried, so he was temporarily kept in the hospital with intravenous rehydration and intravenous infusion of ribavirin injection + glucose sodium chloride injection and potassium chloride injection. After treatment, the child’s diarrhea symptoms improved, her spirit improved, and her tears and urine volume increased. Since her condition tended to improve and her dehydration symptoms were corrected, she was advised to take oral montelukast + Clostridium typhimurium live tablets for 7 days, together with oral rehydration salts III for 3 days, and was followed up at the outpatient clinic with medication.
III. Treatment effect
The child came to the hospital with mental weakness, reduced tears and urine volume, dry mucous membrane of the mouth and lips, and decreased skin elasticity. Although there was no abnormal change in the routine stool examination, the rotavirus test was positive, so the child was given antiviral treatment + intravenous rehydration fluid for hospital observation as appropriate, and after treatment, the child’s spirit improved, diarrhea symptoms improved, and dehydration symptoms were basically corrected. After outpatient evaluation, the child was advised to take home the medication. After standardized treatment, the child’s diarrhea symptoms completely disappeared and his spirit and appetite returned to normal.
IV. Notes
We are glad that the child’s symptoms have improved after treatment, but we still need to remind the parents to give the child a light diet as much as possible after he goes home, usually by taking small and frequent meals, avoiding overeating and choking when feeding. The child should wash the buttocks in time after each bowel movement to keep the area dry and breathable to avoid the phenomenon of red buttocks. The room where the child lives should be kept at a suitable temperature and humidity. In addition, try not to take the child to crowded public places to avoid cross-infection.
V. Personal insight
Pediatric diarrheal disease caused by rotavirus infection is a common type of pediatric diarrheal disease, typically manifesting as egg-flake soup-like stools and watery stools, and due to the rapid onset of the disease, dehydration often occurs within a short period of time. Infants and children with weak resistance, especially those who are fed artificially, are particularly susceptible to rotavirus. In this case, the diagnosis is clear because of the rapid onset of the disease, the obvious diarrheal symptoms, and the positive fecal rotavirus test. Although this disease is usually self-limiting, the child was given intravenous fluids for observation in the outpatient clinic because he was already mildly dehydrated when he came to the hospital. In conclusion, early diagnosis and treatment of pediatric diarrheal disease is very important.