
August 18, 2008
Other Illnesses, Sick Days
Question from Ironton, Ohio, USA:
My seven-year-old son is been experiencing chronic nighttime vomiting for two weeks. It is usually between 3:00 a.m. and 6:00 a.m. We visited one Emergency Room (ER) and they suggested that he had appendicitis, however, the CT scan did not show inflammation, swelling or any other signs, and his white blood count was 5 with no fever. We left the ER.
Two days later, he vomited again. This time, we checked his ketones and they were elevated. A friend of ours is a registered nurse so she treated him with one liter of fluids. The next night, he vomited again. We then tried another ER. His ketones were elevated, his CO2 was 18, his pH as 7.35, and they admitted him to the PICU. He spent one night in the PICU and then was moved to the floor. He then proceeded to vomit that night. He was discharged and we were told he had a stomach virus. We were in constant contact with his endocrinologist in Cincinnati and they, too, thought it was a virus. We went home from the hospital. On the second night home, he vomited again. The next night was uneventful, but, tonight, he has vomited again.
His blood sugars have been excellent and he has not had ketones for three days. He basically vomits every other night. He does not have a good appetite and has gone from 60 pounds to 55 pounds. He has also complained of headaches. Each time he vomits, he complains of stomach pain around the navel. He has also complained of his legs aching quite often.
We do not know what to do. We are going to contact his endocrinologist and his pediatrician. It seems too have persisted too long to be a virus. Any suggestions would be appreciated. We are confused. We know something is not right with our son, but are told it is a virus. Something tells us it is not a virus since it has lasted two weeks.
Answer:
There are some nonspecific viruses that do just this. Then resolve on their own even though most do not last so long. Ketones just mean insufficient caloric intake or excess loss so it is not diagnostic. Things to consider include thyroid, adrenal and celiac testing. If this persists, other causes of disturbed gastrointestinal motility should be investigated, including diabetic gastroparesis.
SB