Diagnosis: Gastroesophageal Reflux disease /GERD
Treatment: Inpatient Hospital

This is a patient who presented with complaints of 4 to 5 episodes of emesis in one day associated with symptoms of rhinorrhea and sneezing. There was no fever or diarrhea. Emesis was non-projectile and occurred with every feeding. It was described as a moderate amount. The physical examination was unremarkable. The patient was given one bolus of IV fluid. The health plan's determination is upheld in whole. There were no significant physical findings on examination to suggest dehydration. All work up, including a pyloric US to rule out pyloric stenosis, was negative. The management received included a formula change and thickening of the feeds. This patient did not require any highly skilled or technical care to manage safely. The patient did not have any physical findings of significant dehydration at presentation. The patient did not demonstrate any weight loss, only poor weight gain. The patient also had mildly elevated LFTs. An ultrasound (US) was ordered to investigate. The vital signs remained stable throughout the hospital stay. This patient could have been managed at a lower level of care with the IV fluid bolus and a PO trial of the new thickened formula with subsequent discharge and follow up as an outpatient. This patient did not require any highly skilled or technical care to manage.