Presenting Complaints

• 10-year-old male presents with 2 days of nausea and vomiting.

History of Presenting Complaint

• Patient reports sudden onset of nausea and vomiting 2 days ago.
• Nausea is constant and severe, with episodes of vomiting 3-4 times per day.
• Denies any abdominal pain, diarrhea, fever, or recent illness.
• Patient reports eating a hamburger and fries from a local fast food restaurant the day prior to symptom onset.
• No recent travel or sick contacts.

Significant Positives & Negatives For Differentials

Food Poisoning

Positives:

• Recent fast food meal prior to symptom onset
• Sudden onset of nausea and vomiting without other associated symptoms
• No fever, diarrhea, or abdominal pain

Negatives:

• Lack of other gastrointestinal symptoms like diarrhea
• No other reported cases of illness from the same fast food restaurant

Viral Gastroenteritis

Positives:

• Sudden onset of nausea and vomiting without other associated symptoms
• Common in children
• No fever or other systemic symptoms

Negatives:

• No reported sick contacts
• No diarrhea

Appendicitis

Positives:

• Severe nausea and vomiting

Negatives:

• Lack of abdominal pain
• Normal bowel movements

Bowel Obstruction

Positives:

• Persistent vomiting

Negatives:

• Absence of abdominal pain
• Normal bowel movements

Metabolic/Endocrine Disorders

Positives:

• Isolated nausea and vomiting

Negatives:

• Acute presentation
• Lack of other systemic symptoms

Past Medical History

• No significant past medical history.
• Up to date on all childhood vaccinations.

Drug/Medication History

• No regular medications.
• No recent over-the-counter or herbal supplements.

Social History

• Lives at home with parents and younger sibling.
• Attends 5th grade at local elementary school.
• No pets at home.
• No tobacco, alcohol, or drug use.

Family History

• No family history of gastrointestinal disorders or food allergies.

Systems Review

• General: No fever, chills, or weight loss.
• HEENT: No headache, dizziness, or vision changes.
• Respiratory: No cough, shortness of breath, or chest pain.
• Cardiovascular: No palpitations or edema.
• Gastrointestinal: Nausea and vomiting as described above. No abdominal pain, diarrhea, or constipation.
• Genitourinary: No dysuria, hematuria, or incontinence.
• Musculoskeletal: No joint pain or swelling.
• Skin: No rashes or lesions.
• Neurological: No seizures, weakness, or numbness.

Ideas, Concerns & Expectations

• Patient and family are concerned that the nausea and vomiting may be due to food poisoning from the fast food meal.
• They expect that the symptoms will resolve with time and appropriate treatment.

Case Presentation

Based on the patient's presentation and the differential diagnosis, the most likely diagnosis is acute viral gastroenteritis. The sudden onset of nausea and vomiting without other associated symptoms, lack of fever or diarrhea, and common occurrence in children support this diagnosis. While food poisoning is also a consideration given the recent fast food meal, the lack of other gastrointestinal symptoms makes this less likely. The other differential diagnoses, such as appendicitis and bowel obstruction, are less likely given the absence of abdominal pain and normal bowel movements.