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Infant started vomiting, have loss of appetite, dry lips and no fever. What cure should be done?

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Practicing since : 1982
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I have a 20 month old otherwise healthy and vibrant little girl who eats, drinks and sleeps well. Yesterday she appeared to be slightly off her food (normally it doesn't touch the sides!) and last night she vomited around 22.30hrs (1st time she has done this apart from the odd belch from a little too much milk when younger) and brought up her stomach contents. After being cleaned up she went to bed and slept through to 7am. However during today she has been quite lethargic, slept intermittently, not eaten and only had sips of water. She has also vomited small amounts within 30 mins of taking the water sips. As the day has progressed the colour of the liquid she is bringing up has turned brown. She is not running a temperature, her extremities are warm and a normal colour but she has dry lips. I'm a little concerned about the colour of the vomit.
Posted Mon, 18 Feb 2013 in Child Health
Answered by Dr. Taher Kagalwala 17 minutes later
Dear friend,

Thank you for seeking help through this website. I am Dr. Taher, and would take the XXXXXXX to delve into your precious one's problem.

It appears to me that your daughter has started vomiting repeatedly since the last night, and as you said, the colour of the vomit has become brown ... are you CERTAIN that this is brown and not just yellow or a darker shade of yellow? Brown flecks mixed with vomit or a brown-coloured vomit usually indicates regurgitation of previously eaten food, and if that is the case, you probably shouldn't be all that concerned.

However, the real danger is that a typical brown vomit indicates that the child either swallowed blood (in the most harmless case, while brushing her teeth, her gums bleed and the blood then gets swallowed, or she cuts her tongue while playing and that blood gets swallowed, etc.) or she actually BLED inside the mouth, food-pipe or the stomach. When blood comes in contact with the hydrochloric acid (HCl) of the stomach and gets denatured into a brown coloured compound (acid-hematin).

I do not personally think that the child bled into the alimentary canal, because such bleeding is invariably accompanied by SOME OTHER symptom of a serious illness, not just refusal to eat and weakness, as you have stated.

What I would recommend is that you take her to the ER of your designated hospital in the NHS and seek attention from a paediatrician for hands-on assessment ... right away. If she hasn't had the appropriate quantity of liquids or food, she might even need some intravenous therapy.

Please revert to me within the next eight hours so that we are able to coordinate the next phase of her therapy.

With best wishes for a quick resolution of her problems.

- Dr Taher
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