2026 i-Human Pediatrics Comprehensive
Case Study: Courtney Graham – 19-
Month-Old Female Presenting with
Vomiting and Diarrhea | Expert Clinical
Evaluation & Decision-Making Guide |
Complete HPI, ROS, Developmental
Assessment, Physical Examination,
,| Characteristic | Details |
|----------------|---------|
| **Patient Name** | Courtney Graham |
| **Age** | 19 months (18 months in some versions) |
| **Sex** | Female |
| **Ethnicity** | African American |
| **Height** | 2'6" to 2'8" (76-81 cm) |
| **Weight (current)** | 11.2-11.8 kg (24.7-26.0 lbs) |
| **Weight (baseline)** | ~11.5-11.6 kg |
| **Weight loss** | ~0.3-0.6 kg (~3-7% acute loss) |
| **Illness duration** | ~48 hours |
| **Chief complaint** | "Vomiting and diarrhea" |
| **Setting** | Outpatient pediatric clinic |
| **Source of Information** | Mother (Isabel) – reliable historian |
**Presenting Situation:** Courtney Graham is a previously healthy 19-month-old female brought to the
pediatric urgent care clinic by her mother with a 2-day history of vomiting and watery diarrhea.
Courtney is reportedly active at baseline but has been notably fussier than usual, with decreased oral
intake and fewer wet diapers since symptom onset. Her mother is visibly anxious and requesting
guidance on management, medication safety, and when to escalate care .
## SECTION 02: Complete History of Presenting Illness (HPI)
### Complete Interview Questions & Answers
| Category | Question | Mother's Response |
, |----------|----------|-------------------|
| **Opening** | How can I help her today? | "She has been vomiting and having diarrhea in her diaper
for two days. She doesn't really want to eat anything either and I'm pretty worried. Her sister had similar
symptoms last week, especially the diarrhea, but she got better within two days." |
| **Opening** | Does she have any other symptoms or concerns? | "No, not really. I just want her to
start eating again." |
| **Fever** | Has she had any fevers? | "Nope." (Some versions report low-grade fever up to 101.2°F) |
| **Chills** | Has she had any chills? | "She hasn't had that problem." |
| **Pain** | Does she have any pain? | "She hasn't said she has pain there." |
| **Diarrhea Hx** | Has she had diarrhea like this before? | "No." |
| **Diarrhea Onset** | When did her diarrhea start? | "Two days ago." |
| **Diarrhea Severity** | How severe is the diarrhea? | "Moderate, I guess." |
| **Events surrounding start** | What were the events? | "It started two days ago. She started
vomiting as well and right from the beginning she had diarrhea – just watery and runny. She is also really
irritable and refusing food. She is taking Pedialyte and some milk." |
| **Diarrhea pattern** | Does it come and go? | "No, for the last two days, she has had runny, watery
stools. I mean I haven't changed a diaper that had a solid stool on it." |
| **Aggravating/Relieving** | Anything make it better or worse? | "Not really." |
| **Treatment** | What treatment has she had? | "Nothing." |
| **Stool frequency** | How many stool diapers per day? | "Before this she used to have two formed
stools a day and now for the last two days, she's had watery stools three, maybe four times a day." |
| **Stool characteristics** | Any blood or mucus? | "No." |
| **Constipation Hx** | Problem with constipation? | "No." |
| **Dairy relation** | Do milk products worsen symptoms? | "Nope." |
| **Weight loss** | Lost weight since being sick? | "Since being sick? I hope not." |
| **Nausea/Vomiting** | Does she have nausea and vomiting? | "Yes." |
| **Vomiting onset** | When did vomiting start? | "Two days ago." |
| **Vomitus appearance** | What does vomit look like? | "Like milk and small bits of food – just stuff
she ate." |
Case Study: Courtney Graham – 19-
Month-Old Female Presenting with
Vomiting and Diarrhea | Expert Clinical
Evaluation & Decision-Making Guide |
Complete HPI, ROS, Developmental
Assessment, Physical Examination,
,| Characteristic | Details |
|----------------|---------|
| **Patient Name** | Courtney Graham |
| **Age** | 19 months (18 months in some versions) |
| **Sex** | Female |
| **Ethnicity** | African American |
| **Height** | 2'6" to 2'8" (76-81 cm) |
| **Weight (current)** | 11.2-11.8 kg (24.7-26.0 lbs) |
| **Weight (baseline)** | ~11.5-11.6 kg |
| **Weight loss** | ~0.3-0.6 kg (~3-7% acute loss) |
| **Illness duration** | ~48 hours |
| **Chief complaint** | "Vomiting and diarrhea" |
| **Setting** | Outpatient pediatric clinic |
| **Source of Information** | Mother (Isabel) – reliable historian |
**Presenting Situation:** Courtney Graham is a previously healthy 19-month-old female brought to the
pediatric urgent care clinic by her mother with a 2-day history of vomiting and watery diarrhea.
Courtney is reportedly active at baseline but has been notably fussier than usual, with decreased oral
intake and fewer wet diapers since symptom onset. Her mother is visibly anxious and requesting
guidance on management, medication safety, and when to escalate care .
## SECTION 02: Complete History of Presenting Illness (HPI)
### Complete Interview Questions & Answers
| Category | Question | Mother's Response |
, |----------|----------|-------------------|
| **Opening** | How can I help her today? | "She has been vomiting and having diarrhea in her diaper
for two days. She doesn't really want to eat anything either and I'm pretty worried. Her sister had similar
symptoms last week, especially the diarrhea, but she got better within two days." |
| **Opening** | Does she have any other symptoms or concerns? | "No, not really. I just want her to
start eating again." |
| **Fever** | Has she had any fevers? | "Nope." (Some versions report low-grade fever up to 101.2°F) |
| **Chills** | Has she had any chills? | "She hasn't had that problem." |
| **Pain** | Does she have any pain? | "She hasn't said she has pain there." |
| **Diarrhea Hx** | Has she had diarrhea like this before? | "No." |
| **Diarrhea Onset** | When did her diarrhea start? | "Two days ago." |
| **Diarrhea Severity** | How severe is the diarrhea? | "Moderate, I guess." |
| **Events surrounding start** | What were the events? | "It started two days ago. She started
vomiting as well and right from the beginning she had diarrhea – just watery and runny. She is also really
irritable and refusing food. She is taking Pedialyte and some milk." |
| **Diarrhea pattern** | Does it come and go? | "No, for the last two days, she has had runny, watery
stools. I mean I haven't changed a diaper that had a solid stool on it." |
| **Aggravating/Relieving** | Anything make it better or worse? | "Not really." |
| **Treatment** | What treatment has she had? | "Nothing." |
| **Stool frequency** | How many stool diapers per day? | "Before this she used to have two formed
stools a day and now for the last two days, she's had watery stools three, maybe four times a day." |
| **Stool characteristics** | Any blood or mucus? | "No." |
| **Constipation Hx** | Problem with constipation? | "No." |
| **Dairy relation** | Do milk products worsen symptoms? | "Nope." |
| **Weight loss** | Lost weight since being sick? | "Since being sick? I hope not." |
| **Nausea/Vomiting** | Does she have nausea and vomiting? | "Yes." |
| **Vomiting onset** | When did vomiting start? | "Two days ago." |
| **Vomitus appearance** | What does vomit look like? | "Like milk and small bits of food – just stuff
she ate." |
