Pediatricians often state their favorite diagnosis is a nursemaid’s elbow. A child presents to the emergency department with arm pain and, after a quick maneuver, the problem is fixed. Within minutes, you have the satisfaction of seeing the child back to normal.

I experienced similar gratification with another diagnosis; severe hypovolemia (markedly decreased blood volume usually from diarrhea, vomiting or bleeding). Recently, an 11 month-old patient presented with many days of profuse, watery diarrhea. Her mother recognized her child’s illness as severe, but she delayed seeking care hoping her child would spontaneously improve. She felt the medical bills for her daughter would be financially ruinous and she had other children to provide for.  

When I initially saw the patient, she was limp, unresponsive and the puncture from the IV needle did not arouse her. Her eyes were profoundly sunken, her lips were cracked and her skin was cool, wrinkled and tented. After three IV fluid boluses (large amounts of liquid) in less than one hour, she was a new girl; awake, alert, crying and trying to remove her IV from her arm.

By the following morning, her eyes appeared normal, her lips were moist and her skin had improved. She was soon back being a regular child.

It is a great experience to witness such a dramatic, rapid change in a patient’s clinical status.


One Response to “Gratifying”

  1. Francisco Acosta Says:

    Thanks for the video.

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