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Case Discussion

Dr. Pohl

Dr. Gupta

Pertinent History

5 year old male with 2 year history of intermittent vomiting of a cyclic nature (CVS?)

2 prior episodes of dehydration requiring hospitalization.

Previous Giardia infection (pertinent?)

Brother with “wheat allergy” and Giardia infection

Mother with IBS.

Father and paternal relatives with stomach problems and wheat allergy.

Pertinent History

Serum bicarbonate 16

Urine organic acid screen: Increased 3-hydroxybutyric and acetoacetic acid consistent with physiologic ketosis or disorder of fatty acid oxidation.

Urine analysis: Sp. gravity 1.032, pH 5.5, 4+ ketones , negative blood / glucose / protein / nitrite / leukocyte esterase / bilirubin. 0 RBCs, 0 WBCs, 0 bacteria.

 MRI: Scattered areas of increased signal intensity on the FLAIR images particularly noted in the subcortical white matter regions.

During the work-up, an upper endoscopy was performed.

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