Received Nov 25, 2025
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| DTAPHEPBIP | DTAP + HEPB + IPV (PEDIARIX) | GLAXOSMITHKLINE BIOLOGICALS | 2 | TE499 | IM / RL |
| HIBV | HIB (HIBERIX) | GLAXOSMITHKLINE BIOLOGICALS | 2 | 7329M | IM / LL |
| PNC20 | PNEUMO (PREVNAR20) | PFIZER\WYETH | 2 | LX2498 | IM / LL |
| RV1 | ROTAVIRUS (ROTARIX) | GLAXOSMITHKLINE BIOLOGICALS | 2 | EX434 | PO / MO |
Information Below Brief HPI: Patient is a 4 m.o. male born FT with no prior medical history presenting for excessive irritability. He was in his usual state of health on 9/17 when he began crying inconsolably after receiving his 4 month vaccines that day. On 9/18, he developed cough, congestion, emesis and became excessively irritable. When trying to feed, the patient would arch his back and reflux breast milk and mucous. He was constantly crying and difficult to console, and so was brought to the ED. In the ED, he was afebrile with normal vital signs: HR 149, RR 36, SpO2 100% on room air. Work up found normal electrolytes, a mildly elevated anion gap of 18, AST 72 and normal ALT and alkaline phosphatase, elevated procalcitonin and a lactate of 6.2. Viral panel positive for rhinoenterovirus. Abdominal x-ray found air-filled loops of large and small bowel throughout the abdomen. The patient received rectal irrigation and tolerated the procedure well. Hospital Course: The patient was assessed after arrival to the floor. He was fussy but consolable. Abdominal examination was benign. Patient was given simethicone drops and tylenol as needed. He received a follow up abdominal x-ray that found reduced amounts of bowel gas. He was able to feed well with no reflux. Parents were agreeable to discharge, and received strict return precautions, anticipatory guidance and instructions to follow up. Went home with simethicone drops.
None known
None known
Vitamin D
NA
Information Below X-ray abdomen ap 1 view XR ABDOMEN AP 1 VW HISTORY: Ileus, abdominal distention COMPARISON: 9/18/2025 TECHNIQUE: Single AP supine view of the abdomen obtained. IMPRESSION: Reduced distention of gas-filled bowel loops throughout the abdomen. Air is now seen in the rectum. No pneumatosis or portal venous gas. X-ray abdomen ap 1 view XR ABDOMEN 1 VIEW HISTORY: Inconsolable, not feeding COMPARISON: None IMPRESSION: * Prominent air-filled small and large bowel loops throughout the abdomen, nonspecific though may relate to diffuse ileus or potentially distal obstruction. No pneumatosis or portal venous gas. Additional information for Item 19: Significant Lab/Imaging Studies: Recent Results (from the past 24 hours) Extra Urine Collection Time: 09/19/25 3:56 AM Specimen: Urine, Clean Catch Midstream Result Value Ref Range Extra Tube Auto Resulted Comprehensive metabolic panel Collection Time: 09/19/25 4:17 AM Result Value Ref Range SODIUM 138 134 - 146 mmol/L POTASSIUM 4.1 4.0 - 6.0 mmol/L CHLORIDE 102 98 - 109 mmol/L CARBON DIOXIDE 18 (L) 22 - 32 mmol/L ANION GAP 18 (H) 5 - 15 mmol/L BLOOD UREA NITROGEN 6 5 - 23 mg/dL CREATININE 0.26 (L) 0.30 - 0.60 mg/dL GLUCOSE 134 (H) 55 - 90 mg/dL CALCIUM 10.6 7.3 - 12.0 mg/dL TOTAL PROTEIN 6.8 6.0 - 8.0 g/dL ALBUMIN 4.6 3.2 - 5.3 g/dL ALKALINE PHOSPHATASE 320 137 - 535 U/L AST 72 (H) <=41 U/L ALT 32 <=40 U/L BILIRUBIN,TOTAL 0.6 0.3 - 1.2 mg/dL Narrative The calculation to estimate GFR is not valid on patients <18 yrs, so GFR is not reported. Lipase Collection Time: 09/19/25 4:17 AM Result Value Ref Range LIPASE 34 11 - 82 U/L Lactate w/ Reflex Collection Time: 09/19/25 4:17 AM Result Value Ref Range LACTATE W/REFLEX 6.2 (HH) 0.4 - 2.0 mmol/L Magnesium Collection Time: 09/19/25 4:17 AM Result Value Ref Range MAGNESIUM 2.4 1.8 - 2.6 mg/dL Procalcitonin Collection Time: 09/19/25 4:17 AM Result Value Ref Range PROCALCITONIN 0.11 (H) <0.05 ng/mL Narrative <0.50 ng/mL - Low risk of severe sepsis and/or septic shock. <2.00 ng/mL - Recommend retesting within 6-24 hours. >2.00 ng/mL - High risk of sepsis and/or septic shock. POCT Nursing Urine Macroscopic UA Collection Time: 09/19/25 4:25 AM Result Value Ref Range POC Urine Specific Gravity 1.010 1.010, 1.015, 1.020, 1.025 POC Urine Leukocyte Esterase Negative Negative POC Urine Nitrite Negative Negative POC Urine pH 6.0 5.0, 6.0, 6.5, 7.0, 7.5, 8.0, 8.5, 5.5 POC Urine Protein Negative Negative POC Urine Glucose Negative Negative POC Urine Ketones Negative Negative POC Urine Urobilinogen 0.2 E.U./dL POC Urine Bilirubin Negative Negative POC Urine Blood/HGB Negative Negative Rainbow draw *Canceled* Collection Time: 09/19/25 4:25 AM Narrative The following orders were created for panel order Rainbow draw. Procedure Abnormality Status --------- ----------- ------ Please view results for these tests on the individual orders. Resp Pathogens Panel/SARS CoV-2 Collection Time: 09/19/25 4:37 AM Result Value Ref Range SARS COV 2 BY PCR Not Detected Not Detected ADENOVIRUS Not Detected Not Detected CORONAVIRUS 229E Not Detected Not Detected CORONAVIRUS HKU1 Not Detected Not Detected CORONAVIRUS NL63 Not Detected Not Detected CORONAVIRUS OC43 Not Detected Not Detected HUMAN METAPNEUVIRUS Not Detected Not Detected RHINO/ENTEROVIRUS Detected (A) Not Detected INFLUENZA A Not Detected Not Detected INFLUENZA B Not Detected Not Detected PARAINFLUENZA 1 Not Detected Not Detected PARAINFLUENZA 2 Not Detected Not Detected PARAINFLUENZA 3 Not Detected Not Detected PARAINFLUENZA 4 Not Detected Not Detected RESP SYNCYTIAL VIRUS Not Detected Not Detected BORD PARAPERTUSSIS Not Detected Not Detected BORDETELLA PERTUSSIS Not Detected Not Detected CHLAM.PNEUMONIAE Not Detected Not Detected MYCOPLASMA PNEUMONIAE Not Detected Not Detected