HISTORIAN: C. B. (Guardian, lives with patient)
This six year old patient has no known chronic illnesses and was well until six days prior to presentation when she began experiencing a severe frontal, non- radiating headache with no known aggravating or relieving factors. Her guardian denies any history of associated photophobia or phonophobia.
Five days prior to presentation, she developed a high fever (subjectively measured by her guardian who notes that she was hot to touch) which was constant in nature and associated with occasional chills. Her guardian reports only minimal relief of the fever with Panadol ®(Acetominophen) and tepid sponging. There were nil associated respiratory or urinary symptoms, however, patient’s guardian reports that patient’s activity level was markedly decreased and that she was extremely lethargic . She also gives a history of decreased appetite.
Two days prior to presentation, the patient experienced one episode of non-projectile, non-bilious vomiting . The vomitus consisted of a moderate amount of previously ingested food material with no blood or mucus. She also had three? Episodes of a moderate amount (exemplied by what???) of foul-smelling, yellow loose stools which did not contain blood or mucus. No known ill contacts. No recent weight loss. No history of recent travel.
Her guardian gives no history of sunken eyes, dry cracked lips, excessive thirst, or decreased urine output prior to presentation. She states that when the patient cried, tears were present.
The patient’s guardian sought medical attention at a public institution at this point, where she was told that the patient was likely suffering from an acute viral illness and advised to