Case Study – A 23-month-old, 15.4 kg male child presented to theemergency department (ED) through triage with his mother. Themother stated that she noticed he had a fever that morning and hehad not been eating well since the previous night. She indicatedthat her son vomited green fluid once that morning and wascomplaining that his stomach hurt. Once in the treatment room, themother denied any past medical issues. There were no knowncomplications at birth, and she denied any drug use duringpregnancy. The patient had no known allergies and was up to date onhis required childhood immunizations but had not received a fluvaccination. Initial vital signs were as follows: heart rate 190beats per minute, respiratory rate 40 breaths per minute, bloodpressure 100/50 mm Hg, temperature 39.2°C, oxygen saturation 98% onroom air, capillary refill less than 2 seconds. The child appearedtoxic as evidenced by his poor response to interaction andlistlessness. Upon further examination, the patient’s skin was dry,dusky, and appeared ashen. He was unable to follow objects with hisgaze, and his pupils were dilated with sluggish response to light.He did not produce tears. Lung sounds were clear and equalbilaterally, and no respiratory distress was noted. The patient’spulse was rapid, regular, and bounding. The complete blood cellcount reported a white blood cell count of 4.5 x 103/mcL, with zeroneutrophils both segmented and absolute. His hemoglobin was 12.0g/dL, his hematocrit was 39%, and he had an elevated lymphocytecount of 89%. A rapid influenza screen was positive for influenzaA.
What is your initial impression of this patient?
What is the diagnosis?
What is your recommended treatment plan?
