Pediatric Puzzler. October 2007. HPI. CC: “I keep vomiting” HPI: 9 yo male presents with one week history of intermittent vomiting. He was punched in the head one week prior but had no outward signs of injury, though he did have emesis on the day of the injury.
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Top 3 Differentials
Top 3 Tests
Intermittent Vomiting x 1 wk
Acute Mental Status Changes
In an otherwise well child
Bolus given. Sent Home
Bolus given. Admitted.
What do you do?
Any further tests?
Has anything entered into your index of suspicion?
9 yo male with acute mental status changes, vomiting and hyperammonemia.
Urine OA came back
Elevated orotic acid
Elevated glutamine level
Thank you to Dr. Allison Conravey and Dr. Marble for their expertise!
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