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13 month child having pus cell in stool. fever, loose motions and vomiting. What should be done?

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Pediatrician, Infectious Diseases
Practicing since : 2005
Answered : 1528 Questions
Hi, my 13 month old son detected 30% pus cells in stools. He is having fever (shoots upto 104 F), loose motions like water after anything he eats, vomiting 3-4 times a day, not willing to eat anything. The treatment going on is DRS solution (sodium Chloride soln) and some zinc antibiotics. Please suggest what should be done.The stools are of XXXXXXX color. condition of the patient is very bad, admitted to hospital 3 days ago.He is very dull all the time and does not take interest in anything like before e.g playing, touching vibrant lights, new objects, talking.
Posted Wed, 15 Aug 2012 in Child Health
Answered by Dr. Hema Yadav 6 hours later
Thanks for posting your query.
According to the details you have provided, your son is most probably suffering
from gastroenteritis causing dehydration and irritability and lethargy .
The treatment going on seems appropriate .However if there is not much relief then I would advise the following;
1. The vomiting and diarrhoea can be symptomatically improved by giving an antiemetic like domeperidone or ondansetron and probiotic like enterogermina with zinc supplement like zinconia etc.
2. The dehydration has to be prevented by appropriate oral or Iv rehydration( if patient hospitalized) .
3. The stool culture and antibiotic sensitivity test should be done and depending on the report a change of antibiotic or continuation of same to course ccompletion should be considered.In resistant infantile diarrhoea oral colistin might be preferred.
4. If the child has pain in abdomen the doctor might prescribe antispasmodics like dicylomine .
5. With such treatment the child's condition should improve in next 48 hours and small frequent liquid or semisolid diet should be given.
Please do not panic and discuss the above with your doctor.
Remember that rehydration is the most important step in treatment of diarrhoea and as a parent you can ensure that child continues to have frequent sips of ORS solution which will help in faster recovery.
Hope I have answered your query.
Kindly accept my answer if you have no further queries.
Wishing your child a speedy recovery.
Above answer was peer-reviewed by
Follow-up: 13 month child having pus cell in stool. fever, loose motions and vomiting. What should be done? 17 hours later
Thanks for the reply doctor.

For vomiting and diarrhoea, ondansetron and enterogermina with zinc supplement is given to the patient, Iv rehydration is continued from last 3 days. Patient is not showing any signs of pain in abdomen, however, the abdomen seems to be be swallow than usual. He is passing stools like plain water. In last 24 hours , he has passed motions approx 30 times, sometime greenish with lumps like peas and sometimes like plain water. giving Oral fluids as well (curd, coco water, rice congee, clear veg soup, all in form of water). patient starts vomiting if any semisolid is given like blended moong daal khichdi.

Stools are not much foul smelling, but are sticky sometimes.

The condition of the patient is getting worse day by day. In last 24 hours, he opened eyes only for 10 mins. However, he is able to recognize parents. but reported extremely lethargic.

His lips are very dry and caught up mouth ulcers, doc has prescribed the ointment for the ulcers.

doc says that there is no sign of dehydration as the patient is continuously given IV fluids, still urine passing interval is about 7 to 8 hours.

Chest x XXXXXXX for cough is also clear.

For loose motions , sporlac powder has been given but the patient is not responding to it.

Current status as per the doctor is that there was some stomach infection and it has got into blood stream. Please suggest if it is serious problem and require special treatment.

Please suggest if it is ok to ask the current doctor for Stool test report and blood test report, so that I can post it here.

Could you please suggest a line of treatment in case the patient is detected positive for gastroenteritis.

Also, Please suggest the symptoms of infection of Rotavirus. However, the patient has been given scheduled rota virus immunization injection.
Answered by Dr. Hema Yadav 48 minutes later
Thanks for the follow up.
Yes , the condition does seem to be moderate although not very serious if the patient is passing 30 stools and urination is infrequent and mouth dry.The symptomatic treatment going on seems appropriate however you haven't mentioned if any intravenous antibiotics are started.
As per your description the symptoms could be of a bacterial gastroenteritis with sepsis ( if doctor mentions spread to blood stream) .Rotavirus is a common cause however unlikely if vaccinated infant.
It is very difficult to comment on the line of treatment without any clinical findings and reports.
Please feel free to discuss your child's condition with the treating doctor , the exact diagnosis , his reports and the prognosis.You have the right to know his reports.
If the child has been in the hospital for three days he might have undergone a CBC , a stool routine and culture test and serum creatinine & electrolytes ( kidney function test) all of which might help in knowing the severity of the problem .
If the child is passing less urine the minimal rate should be about 1 ml/ kg/ hr say 10ml of urine per hour ie atleast 250 ml daily . If he is passing urine less frequently but in adequate quantity and serum creatinine& electrolytes is normal then there is no severe dehydration and the prognosis is better.
I assume that the doctor is maintaining his hydration as Iv fluids are going on.So please do not panic .
If your child has thirst , moist tongue , pulse and blood pressure are normal then there is not much dehydration and the lethargy is due to diarrhoea ( loss of nutrients).
As I said the treatment going on seems appropriate but I would prefer to give the child an antibiotic ( if not given) . If your doctor has confirmed a viral infection then there is no need of antibiotic .
To be able to guide you further I would appreciate if you can provide more details like blood counts, platelet count, renal profile and vital parameters( Bp , pulse) , stool test diagnosis etc
Hope I have been of some help.
Awaiting your response,
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