I. Problem. A 9-month-old boy has a 2-day history of watery diarrhea, vomiting, and decreased urine output. He is afebrile but irritable, with sunken eyes, thick tenacious saliva, and poor skin turgor.

II. Immediate Questions

A. How old is patient? In a young infant, the intestinal mucosa tends to be more permeable to water than in an older child or adult. This can result in greater net fluid and electrolyte losses. Diarrhea in the first few months of life requires more immediate attention.

B. What are the vital signs? Tachycardia suggests volume depletion. Hypotension suggests hypovolemic or septic shock. Fever implies an infectious etiology. Diarrhea with associated tachycardia, hypotension, or fever should be evaluated immediately.

C. Is diarrhea grossly bloody? Bloody diarrhea is seen with invasive bacterial infections, ischemic bowel or infarction, allergic phenomenon or inflammatory bowel disease (IBD). It requires more active and immediate intervention.

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