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.