TABLE 116.2 PEDIATRIC APPENDICITIS SCORE Clinical finding Point Anorexia Nausea or emesis Migration of pain Fever >38°C Pain with cough, percussion, or hopping Right lower quadrant tenderness White blood cell count >10,000/mm3 Absolute band count >7,500/mm3 Total 1 1 2 1 10 At this time, nonperforated pediatric appendicitis primarily is managed surgically although there are ongoing trials of nonoperative treatment with antibiotics for selective cases of early, uncomplicated appendicitis The preoperative preparation of a patient with acute appendicitis should include electrolytes if the patient has been vomiting or has had poor fluid intake for more than a few hours IV fluids should be started with the goal of rapid intravascular expansion and then correction of further fluid deficits Protracted GI losses, as with vomiting, may lead to potassium depletion Initial fluids should include a bolus of isotonic fluid (20 cc/kg), then changed to D5–0.5NS with 10 to 20 mEq/L of potassium These fluids can then be altered, if necessary, once the serum chemistries are known Antibiotics should be administered as soon as the appendicitis is confirmed by imaging or sooner if there are signs of critical illness or peritonitis