- Libraries list
- Accounts list
Maria Guerrero is a 13-year-old female patient who is brought to the emergency room complaining of abdominal pain, vomiting, and dizziness.
She was in school today when she started feeling dizzy and nauseated. She went to the bathroom and threw up.
Her parents picked her up and took her home, where she threw up 5 more times. She has not been able to keep anything down since breakfast and it is now 10 o’ clock at night.
She says her belly hurts all the time, that it feels “achy” and that the pain does not come and go. Nothing seems to make it feel better or feel worse except she does feel lessening of the pain for a few minutes after vomiting. She has not had any diarrhea but has had to pee more frequently than usual the last week and has urinated twice while waiting to see you in the ER. She also says she feels exhausted, and her dad had to carry her in from the waiting room because she was too dizzy and felt too weak to walk without falling. She also complains of feeling horribly thirsty but “I know if I drink anything I will throw up again.” She thinks she usually weighs 115 pounds and was surprised to see her weight was so low on the scale in triage.
| Test | Value |
|---|---|
| T | 97.1 |
| HR | 125 |
| BP | 80/40 |
| Lying Down SpO2 | 99% on room air |
| Weight | 98 lbs |
| BMI | 16 |
Gen: pale, tired appearing, sleepy
HEENT: sclera anicteric, flat neck veins, mucous membranes dry
Chest: tachycardic, lungs clear, I/VII murmur at left sternal border
Abdomen: soft, nondistended, mildly tender to palpation, dull on percussion, no bowel sounds after listening for 60 seconds
Rectal/GU: brown stool, guaiac negative, normal tone
Extremities: cool, no edema, capillary refill > 4 seconds
| Test | Value |
|---|---|
|
Hgb |
16.1 g/dL |
|
Sodium |
138 mEq/L |
|
Potassium |
4.5 mEq/L |
|
Chloride |
102 |
|
Bicarbonate |
8 mmol/L |
|
BUN |
40 mg/dL |
|
Creatinine |
1.8 mg/dL |
|
Glucose |
320 mg/dL |
|
Calcium |
9.1 mEq/dL |
|
AST |
25 units/L |
|
ALT |
30 units/L |
|
Bilirubin |
0.5 mg/dL |
|
Serum amylase |
70 u/L |
|
Serum lipase |
12 u/dL |
|
PT/INR |
12 sec/1.3 |
|
PTT |
22 sec |
ABG:
| Test | Value |
|---|---|
|
pH |
7.21 |
|
PaCO2 |
20 |
|
PaO2 |
95 |
|
HCO3- |
10 |
U/A:
| Test | Value |
|---|---|
|
Sp Grav |
1.050 |
|
Glucose |
750 |
|
Nitrite |
negative |
|
Leukocyte esterase |
neg |
|
Protein |
1+ |
|
WBC |
negative |
|
RBC |
negative |
|
Ketones |
4+ |
She is admitted for hydration and starting treatment of her new condition. Her parents are asked to be present daily for education and training on managing her care and avoiding complications.