Comprehensive Case Study: 18-Month-Old Patient With
Vomiting and Diarrhea | iHuman Case Analysis Week 7
(IHUM 6541) | Walden University 2026
In-depth iHuman case analysis for Week 7 (IHUM 6541) featuring an 18-month-old
pediatric patient with vomiting and diarrhea. Includes assessment, differential diagnoses,
management plan, and Walden University-aligned clinical reasoning. Updated for 2024.
Patient Information
• Age: 18 months
• Sex: Not specified
, • Setting: Pediatric primary/urgent care visit
• Source of History: Parent/primary caregiver
• Chief Complaint: Vomiting and diarrhea
Reason for Encounter
The caregiver presents an 18-month-old child for evaluation due to multiple episodes of
vomiting and diarrhea over the past 24–48 hours, with concern for dehydration and reduced oral
intake.
History of Present Illness (HPI)
The child was in usual state of health until approximately 36 hours prior to presentation, when
vomiting began abruptly. Vomiting has been non-bilious and non-bloody, occurring 4–5 times on
the first day and 2–3 times on the day of presentation. Diarrhea began several hours after the
onset of vomiting, described as loose, watery stools occurring 5–6 times per day without visible
blood or mucus.
The caregiver reports decreased appetite and reduced fluid intake. The child has produced fewer
wet diapers than usual (approximately 2–3 in the past 24 hours compared to a normal of 5–6).
There is associated low-grade fever (maximum reported temperature 100.8°F / 38.2°C). No
cough, rhinorrhea, rash, or ear pulling is noted.
There is no recent travel. The child attends daycare, where several other children reportedly had
similar gastrointestinal symptoms during the past week. No known ingestion of toxins or
medications. No recent antibiotic use.
Past Medical History
• Full-term birth, uncomplicated pregnancy and delivery
• Normal growth and development
• No chronic medical conditions
• No prior hospitalizations
Surgical History
• None
,Medications
• None on a regular basis
Allergies
• No known drug allergies (NKDA)
Immunization Status
• Up to date per CDC schedule
Family History
• Noncontributory
• No family history of gastrointestinal disorders or metabolic disease
Social History
• Lives with parents
• Attends daycare 3–4 days per week
• No tobacco exposure in the home
Review of Systems (ROS)
• General: Decreased activity, mild irritability
• HEENT: No congestion, no ear pain
• Respiratory: No cough or difficulty breathing
• Cardiovascular: No cyanosis or edema
• Gastrointestinal: Positive for vomiting and diarrhea; negative for blood in stool
• Genitourinary: Decreased urine output
• Skin: No rash
• Neurologic: Alert, consolable
, Physical Examination
Vital Signs:
• Temperature: 100.6°F (38.1°C)
• Heart Rate: Mildly elevated for age
• Respiratory Rate: Within normal limits
• Blood Pressure: Age-appropriate
• Oxygen Saturation: 99% on room air
General: Alert toddler, mildly ill-appearing but non-toxic
HEENT:
• Mucous membranes slightly dry
• No sunken eyes
Neck: Supple, no lymphadenopathy
Cardiovascular: Regular rate and rhythm, no murmurs, capillary refill ~2–3 seconds
Respiratory: Clear to auscultation bilaterally
Abdomen: Soft, non-distended, mild diffuse tenderness, no guarding or rebound, normal bowel
sounds
Skin: Warm, no rash, mild decrease in skin turgor
Neurologic: Alert, age-appropriate interaction
Assessment
18-month-old child with acute onset vomiting and diarrhea, most consistent with acute viral
gastroenteritis with mild to moderate dehydration.
Differential Diagnosis
1. Acute viral gastroenteritis (most likely) – common in daycare settings; symptoms
consistent
2. Bacterial gastroenteritis – less likely due to absence of blood, high fever, or severe
abdominal pain
3. Food intolerance or food poisoning – possible but less likely given daycare outbreak
4. Urinary tract infection – considered due to fever, but GI symptoms predominate
5. Intussusception – unlikely due to lack of severe episodic pain or bloody stools
Vomiting and Diarrhea | iHuman Case Analysis Week 7
(IHUM 6541) | Walden University 2026
In-depth iHuman case analysis for Week 7 (IHUM 6541) featuring an 18-month-old
pediatric patient with vomiting and diarrhea. Includes assessment, differential diagnoses,
management plan, and Walden University-aligned clinical reasoning. Updated for 2024.
Patient Information
• Age: 18 months
• Sex: Not specified
, • Setting: Pediatric primary/urgent care visit
• Source of History: Parent/primary caregiver
• Chief Complaint: Vomiting and diarrhea
Reason for Encounter
The caregiver presents an 18-month-old child for evaluation due to multiple episodes of
vomiting and diarrhea over the past 24–48 hours, with concern for dehydration and reduced oral
intake.
History of Present Illness (HPI)
The child was in usual state of health until approximately 36 hours prior to presentation, when
vomiting began abruptly. Vomiting has been non-bilious and non-bloody, occurring 4–5 times on
the first day and 2–3 times on the day of presentation. Diarrhea began several hours after the
onset of vomiting, described as loose, watery stools occurring 5–6 times per day without visible
blood or mucus.
The caregiver reports decreased appetite and reduced fluid intake. The child has produced fewer
wet diapers than usual (approximately 2–3 in the past 24 hours compared to a normal of 5–6).
There is associated low-grade fever (maximum reported temperature 100.8°F / 38.2°C). No
cough, rhinorrhea, rash, or ear pulling is noted.
There is no recent travel. The child attends daycare, where several other children reportedly had
similar gastrointestinal symptoms during the past week. No known ingestion of toxins or
medications. No recent antibiotic use.
Past Medical History
• Full-term birth, uncomplicated pregnancy and delivery
• Normal growth and development
• No chronic medical conditions
• No prior hospitalizations
Surgical History
• None
,Medications
• None on a regular basis
Allergies
• No known drug allergies (NKDA)
Immunization Status
• Up to date per CDC schedule
Family History
• Noncontributory
• No family history of gastrointestinal disorders or metabolic disease
Social History
• Lives with parents
• Attends daycare 3–4 days per week
• No tobacco exposure in the home
Review of Systems (ROS)
• General: Decreased activity, mild irritability
• HEENT: No congestion, no ear pain
• Respiratory: No cough or difficulty breathing
• Cardiovascular: No cyanosis or edema
• Gastrointestinal: Positive for vomiting and diarrhea; negative for blood in stool
• Genitourinary: Decreased urine output
• Skin: No rash
• Neurologic: Alert, consolable
, Physical Examination
Vital Signs:
• Temperature: 100.6°F (38.1°C)
• Heart Rate: Mildly elevated for age
• Respiratory Rate: Within normal limits
• Blood Pressure: Age-appropriate
• Oxygen Saturation: 99% on room air
General: Alert toddler, mildly ill-appearing but non-toxic
HEENT:
• Mucous membranes slightly dry
• No sunken eyes
Neck: Supple, no lymphadenopathy
Cardiovascular: Regular rate and rhythm, no murmurs, capillary refill ~2–3 seconds
Respiratory: Clear to auscultation bilaterally
Abdomen: Soft, non-distended, mild diffuse tenderness, no guarding or rebound, normal bowel
sounds
Skin: Warm, no rash, mild decrease in skin turgor
Neurologic: Alert, age-appropriate interaction
Assessment
18-month-old child with acute onset vomiting and diarrhea, most consistent with acute viral
gastroenteritis with mild to moderate dehydration.
Differential Diagnosis
1. Acute viral gastroenteritis (most likely) – common in daycare settings; symptoms
consistent
2. Bacterial gastroenteritis – less likely due to absence of blood, high fever, or severe
abdominal pain
3. Food intolerance or food poisoning – possible but less likely given daycare outbreak
4. Urinary tract infection – considered due to fever, but GI symptoms predominate
5. Intussusception – unlikely due to lack of severe episodic pain or bloody stools
