Six years old previously fit and healthy patient was presented to ER with 7 days h/o abdominal pain and vomiting. No h/o diarrhoea or fever or rash. He had not been able to eat and drink much since the last 2 days. Passed high coloured urine once only on the day of presentation. Not passed stool for last 72 hours.
On examination: HR 150/min blood pressure 55/43 Cold peripheries Pallor + oedema + Cold periphery Tender epigastrium He received 40 ml/kg fluid bolus in ER and referred to surgical team as acute abdomen +/- obstruction Routine bloods revealed: mild metabolic acidosis with lactate Normal FBC INR 2.3 ALT 2354 Urea 89 Creatinine 2.5 Bilirubin 0.5 An abdominal X-RAY was done and is attached. He was seen by PICU team the following morning because of increasing WOB and oxygen requirement. It was noticed to be hypotensive and tachycardic as well. Point of care US showed moderate…
