Anzeige
Erschienen in:
17.03.2021 | Clinical Quiz
A 17-year-old boy with progressive abdominal pain: Questions
Erschienen in: Pediatric Nephrology | Ausgabe 10/2021
Einloggen, um Zugang zu erhaltenExcerpt
A 17-year-old Black male presented to the emergency department (ED) with 2 days of diffuse abdominal pain accompanied by non-bilious, non-bloody emesis, and diarrhea. He had no significant past medical or social history; his family history was significant for a maternal aunt with lupus. On examination, he was afebrile, and his blood pressure was within normal limits. He improved with supportive care and symptomatic management, so he was discharged from the ED with a diagnosis of acute gastroenteritis. Ten days later, he presented to the ED again with persistent abdominal pain and occasional bloody stools. His vital signs were as follows: temperature 98.1 F, blood pressure 119/72 mmHg, pulse rate 56/min, respiratory rate 16/min, and pulse oxygen saturation of 99% on room air. On examination, he appeared uncomfortable and had exquisite abdominal tenderness in the umbilical and left lower quadrant regions. A gastrointestinal pathogen PCR panel was ordered and was negative for all bacterial and viral organisms tested. SARS-CoV-2 PCR was negative. His laboratory findings are summarized in Table 1.
Table 1
Basic laboratory findings upon initial presentation
|
Patient’s value
|
Reference range
|
|
|---|---|---|
|
WBC
|
23.7 k/μL
|
3.7–11.7 k/μL
|
|
Hemoglobin
|
15.7 gm/dL
|
11.3–15.1 gm/dL
|
|
Hematocrit
|
44.6 %
|
35–46%
|
|
Platelet count
|
319 k/μL
|
135–450 k/μL
|
|
Peripheral blood smear
|
||
|
Absolute basophils
|
0.23 k/μL
|
0.0–0.0 k/μL
|
|
Absolute eosinophils
|
0.23 k/μL
|
0.0–0.3 k/μL
|
|
Absolute lymphocytes
|
1.16 k/μL
|
1.2–5.2 k/μL
|
|
Absolute monocytes
|
2.33 k/μL
|
0.2–0.6 k/μL
|
|
Absolute neutrophils
|
19.31 k/μL
|
1.8–8.0 k/μL
|
|
Schistocytes, ovalocytes
|
Occasional
|
---
|
|
Platelet estimate
|
Normal
|
---
|
|
Sodium
|
128 mmol/L
|
134–144 mmol/L
|
|
Potassium
|
3.9 mmol/L
|
3.4–5.5 mmol/L
|
|
Chloride
|
89 mmol/L
|
98–107 mmol/L
|
|
CO2
|
28 mmol/L
|
20–31 mmol/L
|
|
Blood urea nitrogen
|
16 mg/dL
|
7–21 mg/dL
|
|
Creatinine
|
0.9 mg/dL
|
0.2–1.4 mg/dL
|
|
Glucose
|
98 mg/dL
|
65–110 mg/dL
|
|
Protein
|
6.4 g/dL
|
6.5–9.0 g/dL
|
|
Albumin
|
2.9 g/dL
|
3.0–4.8 g/dL
|
|
Total Bilirubin
|
0.5 mg/dL
|
0.3–1.3 mg/dL
|
|
AST
|
20 U/L
|
8–53 U/L
|
|
ALT
|
38 U/L
|
7–56 U/L
|
|
Alkaline phosphatase
|
126 U/L
|
39–253 U/L
|
|
Lipase
|
24 U/L
|
5–62 U/L
|
|
ESR
|
9 mm/hr
|
0–20 mm/hr
|
|
CRP
|
14.6 mg/dL
|
> 0.4–1.0 mg/dL
|
|
Urinalysis
|
||
|
Ur appearance
|
Clear
|
---
|
|
Bacteria
|
None seen
|
None seen
|
|
Ur bilirubin
|
Negative
|
Negative
|
|
Ur blood
|
3+
|
Negative
|
|
Ur color
|
Yellow
|
Colorless, straw, yellow
|
|
Epithelial cells
|
2–5/HPF
|
0–5/HPF
|
|
Ur glucose
|
Negative
|
Negative
|
|
Granular casts
|
0–2/LPF
|
Negative
|
|
Hyaline casts
|
0–2/LPF
|
0–2/LPF
|
|
Ur ketones
|
Negative
|
Negative
|
|
Leukocyte esterase
|
Negative
|
Negative
|
|
Ur nitrate
|
Negative
|
Negative
|
|
pH, UA
|
6.0
|
5.0–8.5
|
|
Ur protein
|
2+
|
Negative
|
|
RBC, UA
|
5 – 10 /HPF
|
0–2/HPF
|
|
Specific gravity
|
1.020
|
1.003–1.035
|
|
Urobilinogen
|
0.2 EU/dL
|
0.2–1.0 EU/dL
|
|
WBC, UA
|
2–5
|
0–5/HPF
|
|
Fecal calprotectin
|
1140 μg/g
|
< = 49 μg/g
|
|
Fecal occult blood
|
Positive
|
Negative
|