Test yourself then see the explanation of the correct answer:
The vomiting without diarrhea displayed by the 10-month-old in the vignette, along with a full anterior fontanelle in the face of mild dehydration, points to an intracranial process. In addition, the child is exhibiting posturing, not a seizure, from continued overhydration and worsening intracranial pressure following the saline administration. Accordingly, administration of intravenous dexamethasone, along with other measures to treat increased ICP, is most appropriate. Treatment with prochlorperazine will only mask the child’s vomiting. Administration of fosphenytoin or lorazepam is not indicated in the absence of seizures. Continued aggressive hydration will worsen this child’s ICP.
The vomiting without diarrhea displayed by the 10-month-old in the vignette, along with a full anterior fontanelle in the face of mild dehydration, points to an intracranial process. In addition, the child is exhibiting posturing, not a seizure, from continued overhydration and worsening intracranial pressure following the saline administration. Accordingly, administration of intravenous dexamethasone, along with other measures to treat increased ICP, is most appropriate. Treatment with prochlorperazine will only mask the child’s vomiting. Administration of fosphenytoin or lorazepam is not indicated in the absence of seizures. Continued aggressive hydration will worsen this child’s ICP.