You've been called to the emergency department of your hospital to evaluate a 6-month-old Amish girl transferred from another hospital with a five-day history of vomiting and three days of cough, increasing somnolence, weak suck, decreased appetite, decreased output of urine, and pallor. You turn first to the chart for background on this clearly ill baby.

The record shows one episode of postprandial vomiting on the first day of her illness; on the second day, she began vomiting after almost every feeding. The parents reported that the vomitus "looked like milk," contained neither blood nor bile, and was non-projectile.

Over the next three days, the baby's vomiting diminished slightly—as did her appetite. Her parents gave her cod liver oil but no other medications or supplements.

This morning, upon being brought to the other hospital, she was observed to appear sleepy; her face was pale; and her parents reported that her appetite had diminished further. She has not had diarrhea. You proceed to review the history.

Rest of case here (http://studentdoctor.mediwire.com/main/Default.aspx?P=Content&ArticleID=165562)

:)

You've been called to the emergency department of your hospital to evaluate a 6-month-old Amish girl transferred from another hospital with a five-day history of vomiting and three days of cough, increasing somnolence, weak suck, decreased appetite, decreased output of urine, and pallor. You turn first to the chart for background on this clearly ill baby.

The record shows one episode of postprandial vomiting on the first day of her illness; on the second day, she began vomiting after almost every feeding. The parents reported that the vomitus "looked like milk," contained neither blood nor bile, and was non-projectile.

Over the next three days, the baby's vomiting diminished slightly—as did her appetite. Her parents gave her cod liver oil but no other medications or supplements.

This morning, upon being brought to the other hospital, she was observed to appear sleepy; her face was pale; and her parents reported that her appetite had diminished further. She has not had diarrhea. You proceed to review the history.

Rest of case here (http://studentdoctor.mediwire.com/main/Default.aspx?P=Content&ArticleID=165562)

:)
Interesting case. I nailed the exact diagnosis after reading the 6th paragraph.

Interesting case. I nailed the exact diagnosis after reading the 6th paragraph.
Impressive!!! Kwashikor didn't enter my mind until r/o Reyes, hepatic dysfunction, and checked the small molecule IEM. Voila!

Nice work!

:thumbup: :thumbup:

Impressive!!! Kwashikor didn't enter my mind until r/o Reyes, hepatic dysfunction, and checked the small molecule IEM. Voila!

Nice work!

:thumbup: :thumbup:
I figured they were trying to make a point with all the details about the kid's diet. In real life, I doubt I'd make the diagnosis. Besides, 6 months old is a little old for many of those IEMs to begin manifesting, though it can happen.