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Kornhauser Health Sciences Library

Marcus, Maria and John: Case 2

 

The Case

 

Maria Guerrero

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 couple of weeks 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.

 

 

Exam
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: flat neck veins, mucous membranes dry

Chest: tachycardic, lungs clear, I/VII murmur at left sternal border

Abdomen: tender to palpation and 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

Significant findings on diagnostic testing:

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+

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