32-day-old presents with a chief complaint of "nasal congestion and rapid breathing". Mom reports poor feeding and choking with feeds. Had an episode of cyanosis with feed today. She was seen in the ED 2 days ago for similar symptoms but looked well, tolerated an 1 oz feed, and was discharged. They return today because she has only been able to take "2 sips" of formula. No wet diaper since day prior. Has not pooped in 3 days. No fevers. Ex 34 week GA NICU stay for respiratory support.
Vitals: T 98F HR 182 bpm RR 60/min O2 100% RA
Physical exam:
Gen: No acute distress "weak" not vigorous flat/sunken fontanelle
HEENT: Normal
Lungs: clear no retractions or tachypnea no nasal flaring
Heart : s1, s2 no murmurs
Abd: Soft ntnd
Ext: Minimal spontaneous movement wwp good perfusion
Neuro: No focal deficits
ED workup:
Partial sepsis work up, CXR, RVP, IVF bolus, FS
FS 58
VBG 7.31 CO2 42 HCO3 21
WBC 7.66 Hgb 12.3/35.5 Plts288
NA 141 K 5.8 CL 105 CO2 19 AG 17 BUN 21 creatinine < 0.5 Glucose 48
ESR11
What is your current diagnosis?
Pt given IVF bolus x 2, pt did not PO on re-evaluation
Patient admitted to the inpatient floor for further management.
Would you do anything more in the ED?
Read the attached pdf for diagnosis and management 😬