Return to Scenario ListShow Learning Points most relevant to Phase 1:

Infant with vomiting and diarrhoea

Clinical Discipline(s)/Organ System(s)
Digestive System, General Practice, Paediatrics, Emergency Medicine, Gastroenterology & Hepatology
Progress Test Topic(s)
Child health
A 4 month old Indian girl who has had vomiting and diarrhoea for 18 hours presents to hospital. She is alternately irritable and drowsy and is assessed to be severely dehydrated with poor peripheral circulation.
Progress Test-Type Questions:   Question 1 | Question 2 | Question 3
Applied Science for Medicine 
   - Physiology of body fluids, acid base and nutrition
   - Infectious pathogens of gastroenteritis; association with haemolytic-uraemic syndrome (HUS)
   - Immunology and immunisations (rotavirus)
   - Normal growth and development
Clinical and Communication Skills 
   - Basic resuscitation and assessment of shock and hydration status (particularly relating to an infant)
   - Knowledge of where to place peripheral and central lines in a child
   - Recognition and initial management of the septic infant
   - Describe features of vomiting in young infants requiring urgent and/or surgical management (pyloric stenosis, bowel obstruction) and features of vomiting/diarrhoea in older infants (intussusception)
   - Physical examination of the infant including weight (and evaluation of acute weight loss)
   - Take a history of feeding, urinary output (wet nappies)
   - Management of fluid resuscitation
   - Indications for and interpretation of investigations: including stools, full blood count, electrolytes, full septic screen, blood gas
   - Prescribe oral rehydration therapy and determine when intravenous or nasogastric therapy is appropriate
Personal and Professional Skills 
   - Ability to communicate appropriate health information to carers about handwashing and management of rehydration of infant at home; ensure appropriate to health literacy of the family/whānau
   - Communicate empathetically with child and caregivers
Hauora Māori 
   - Awareness of barriers to accessing healthcare
   - Ability to cater for differential health literacy needs of Māori patients and whānau
   - Awareness of differing risk profiles for Māori (and other disadvantaged populations) compared with non-Māori in NZ relevant to gastroenteritis (e.g. water supply in rural areas)
   - Differential access to primary and secondary care health services and quality of medical care for Māori with infectious disease
Population Health 
   - National immunisation schedule and preventable illness by vaccination
   - Access to clean water and public healthcare; remote and farming community water contamination
   - Global health perspective of diarrhoea; leading cause of death and hospitalisation in children
   - Investigation of outbreak, composition of Oral Rehydration Solution (WHO formula)
   - Hand hygiene for community and healthcare workers; personal protective equipment (PPE)
Conditions to be considered relating to this scenario
infectious gastroenteritis (e.g. rotavirus), gastrointestinal upset secondary to antibiotics, infection (urinary, respiratory)
Less common but 'important not to miss'
sepsis (urinary tract infections), meningitis, acute appendicitis, intussusception, diabetic ketoacidosis, pyloric stenosis, bowel obstruction, raised intracranial pressure
outbreak diarrhoea from community water or food contamination, toxin ingestion, haemolytic-uraemic syndrome (HUS)/thrombotic thrombocytopenic purpura (TTP)
Related Scenarios
[Febrile infant]