CASE PRESENTATION
A four-month-old male child was brought to the emergency department by
the parents with complaints of loose stools, projectile non bilious
vomiting, decreased urine output, and failure to feed for three days.
Birth History- The child was born at 37 weeks of gestation by assisted
vaginal delivery (vacuum) with a birth weight of 2.5kg. A single dose of
betamethasone was given nine hours before the birth of the child. He had
cried immediately after birth and the APGAR score was five at one minute
and eight at five minutes. Injection Vit K with Vit D3 oral drops was
given after birth. Routine immunization as per the National Healthcare
System (NHS) was done and breastfeeding was initiated in the hospital
and he was exclusively breastfed to date. He was the first child of a
non-consanguineous couple. There was no family history of any chronic or
genetic diseases.
During the present visit at four months of age, the child looked
dehydrated with sunken eyes and dry oral mucosa. On thorough clinical
examination of the child, the weight was 3.5kg and body length was 60
cm. Mild to moderate fever (temp: 1000F) and
irritability were noted. The blood pressure was 70/36 mmHg, heart rate
was 112 bpm, resp rate was 25/min, SpO2 was 92% at room air, and 97%
on two liters of oxygen. Examination of the respiratory system,
cardiovascular and abdomen were within normal limits. The male genitalia
were correctly identified, hyperpigmentation of the overlying skin was
observed as shown in Fig 1. With the current body weight of 3.57 kg
(i.e., below 10th percentile), the child was labeled under failure to
thrive. The patient was admitted to the pediatric inpatient unit with a
provisional diagnosis of acute gastroenteritis with dehydration and
hypoglycemia for observation and further management.