Approach to vomiting (pediatrics) Quiz: Ace Your Exams
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A 7-year-old boy is brought to the clinic by his mother for evaluation of recurrent vomiting for one year. The episodes occur every few weeks, lasting 1-2 days, in which the patient vomits multiple times an hour. The episodes are associated with headaches and light sensitivity. There is no fever, vision changes, diarrhea, abdominal pain, or recent travel history. The patient’s appetite and growth have been normal, and there is no history of recent illness or medication use. Family history is notable for migraines in a parent. Vital signs are within normal limits. The patient appears well, and the abdominal examination is unremarkable with no tenderness, rebound, or guarding. There is no papilledema. Neurological examination is unremarkable. Laboratory results are shown in the table below. Which of the following additional clinical factors is most likely to be present?
| Laboratory Test | Result |
| Hemoglobin | 13.0 g/dL |
| White blood cell count | 7,200/µL |
| Serum sodium | 137 mEq/L |
| Serum potassium | 3.9 mEq/L |
| Serum bicarbonate | 22 mEq/L |
| Blood urea nitrogen | 16 mg/dL |
| Creatinine | 0.7 mg/dL |
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