Recurrent Vomiting in a 6-year-old Boy
Abstract
A 6-year-old boy presents to the emergency department (ED) with a 1-day history of nonbilious, nonbloody vomiting occurring every 1 to 2 hours. He was not tolerating oral fluids and had decreased urination for 24 hours before presentation. He has nasal congestion and discharge but no fever, abdominal pain, or diarrhea. The parent denies sick contacts and the possibility of ingestions. Vital signs are notable for tachycardia (heart rate, 114 beats/min) and mild hypotension (blood pressure, 88/65 mm Hg). Physical examination reveals a lean boy with dry mucous membranes and normal mental status. Shotty cervical lymph nodes are palpated. Tonsils are mildly enlarged without exudates. Abdomen is soft, without localized tenderness. The remainder of the examination findings are normal.The initial laboratory evaluation in the ED demonstrates a normal white blood cell count of 12,200/μL (12.2 × 109/L), a normal sodium level of 139 mEq/L (139 mmol/L), a potassium level of 4.6 mEq/L (4.6 mmol/L), normal liver and kidney function, mild acidosis with a bicarbonate level of 14 mEq/L (14 mmol/L), and hypoglycemia (serum glucose level, 48 mg/dL [2.66 mmol/L]). Urine analysis shows 3+ ketones. He receives a 5-mL/kg dextrose 10% (D10) bolus, a 10-mL/kg normal saline (NS) bolus, and intravenous (IV) ondansetron in the ED. Hypoglycemia improves initially, but the glucose level drops again to 46 mg/dL (2.55 mmol/L), requiring a second 5-mL/kg D10 bolus. A cortisol level at the time of…
Read the paper
Related studies
- Pathophysiology of Non-IgE-Mediated Food Allergy
- Clinical Management of Pediatric Acute-Onset Neuropsychiatric Syndrome: Part II-Use of Immunomodulatory Therapies
- Effect of Dilute Apple Juice and Preferred Fluids vs Electrolyte Maintenance Solution on Treatment Failure Among Children With Mild Gastroenteritis: A Randomized Clinical Trial
- Cyclic Vomiting Syndrome in Children
- Treatment of norovirus infections: moving antivirals from the bench to the bedside
- Abstracts of the 2012 International Congress of the European Association of Poisons Centres and Clinical Toxicologists, 25 May–1 June 2012, London, UK
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.