Vomiting (bilious or not) is a classic symptom of mechanical intestinal obstruction in children. In the early phases of illness, before a child has developed electrolyte abnormalities (e.g., in a child with pyloric stenosis) or before a child has reached the stage of harboring gangrenous bowel (e.g., internal volvulus), the child's general condition may appear to be good. The child may be hungry immediately after vomiting and even eat vigorously. One must not ignore the possibility of a serious underlying intraabdominal pathologic condition merely because a vomiting child appears to be systemically well.
The emergency physician must evaluate the child's circulatory and volume status and administer boluses of normal saline at 20 mL/kg for any child in shock or dehydrated. A one-time dose of an antiemetic can be given safely to children over 6 months of age. Children with shock or severe dehydration will need consultation. For children who appear systemically well after about 2 h, 30 mL of clear liquids or infant rehydration solution can be provided at 15- to 30-min intervals.
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