Antiemetic drugs were administered and fluid resuscitation with saline bolus was performed, without clinical improvement.
Lately, he started to become lethargic and hyporeactive to pain stimuli. Therefore, Enea was transferred to our tertiary care hospital, where showed worsening clinical condition, becoming pallid, lethargic, whining and hyporeactive.
Vital signs were T 37.3°C, heart rate 142/min, respiration rate 40/min, SaO2 95%, blood pressure 121/84 mmHg. Clinical exam showed moderate-severe dehydration. At this point, the neurological examination clearly revealed fluctuating levels of consciousness, without focal neural deficit.