Case 4: Fever, Vomiting, and Abdominal Pain in a 23-month-old Girl

Abstract

1. Brenna Keane, DO*\n2. Paul Whalen, MD*,†\n\n\n \n\n1. *Carilion Children’s, Carilion Roanoke Memorial Hospital, Roanoke, VA\n\n2. †Virginia Tech Carilion School of Medicine, Roanoke, VA\n\nA previously healthy 23-month-old girl presents to the emergency department with a 1-week history of fever (maximum temperature, 104.6°F [40.3°C]), vomiting, and abdominal pain. Vomiting occurs 3 to 4 times daily, and emesis is described as nonbloody and nonbilious. Her parents report that the patient has also been intermittently crying out in pain, clutching her belly. Associated symptoms include fussiness, decreased oral intake, and decreased urine output.\n\nOn initial physical examination the girl is sleeping. Her temperature is 98.6°F (37.0°C), heart rate is 137 beats/min, respiratory rate is 30 breaths/min, blood pressure is 104/69 mm Hg, and oxygen saturation is 100% on room air. She has dry lips, a mildly distended abdomen, and obvious facial grimacing (during sleep) with generalized …