Approach to vomiting (pediatrics) Quiz: Ace Your Exams
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A 13-year-old girl is brought to the clinic for evaluation of recurrent episodes of vomiting for two months. The vomiting is sporadic, non-bilious, and non-bloody, typically occurring after meals. The patient also reports occasional diarrhea, bloating, fatigue, and decreased appetite. Parents are concerned because of unintentional weight loss of 3 kg (6.6 lbs.). Past medical history includes type 1 diabetes mellitus, diagnosed one year ago, which has been well-controlled. Growth is at the 15th percentile for weight and the 25th percentile for height. Vital signs are within normal limits. Physical examination reveals abdominal distension but no tenderness or organomegaly. Laboratory results are shown below. Which of the following is the best next step in management?
| Laboratory Test | Result |
| Hemoglobin | 11.0 g/dL |
| Mean corpuscular volume | 74 fL |
| Serum glucose | 145 mg/dL |
| Serum sodium | 139 mEq/L |
| Serum potassium | 4.0 mEq/L |
| Serum bicarbonate | 23 mEq/L |
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