Citation

Hunter G, Blankenburg R, Andrews J, Stevenson T. Pediatrics 2018; 141(1): e20170291.

Copyright

(Copyright © 2018, American Academy of Pediatrics)

DOI

10.1542/peds.2017-0291

PMID

29208727

Abstract

A previously healthy 16-year-old girl presented to the emergency department with 1 week of severe, diffuse abdominal pain and constipation, as well as several episodes of nonbloody, nonbilious emesis. Her symptoms began several days after she decreased her caloric intake in an attempt to lose weight. She had been drinking 48 to 60 oz of water per day for several days before admission in an attempt to ameliorate her constipation. She also admits to drinking alcohol the night before her pain began. She had visited several other emergency departments before her presentation to our hospital, and she had been sent home on a bowel regimen without amelioration of her symptoms. On arrival to our emergency department, she described severe diffuse abdominal pain. Her abdomen was tender to palpation throughout but soft with no rebound tenderness or peritoneal signs. The remainder of her physical examination yielded normal results. She was found to have hyponatremia with a sodium level of 122 and no neurologic sequelae. Abdominal radiograph showed moderate constipation but her abdominal pain continued even after bowel cleanout. The home, education, activities, drugs, sex, suicide, and safety assessment revealed several stressors, including a recent suicide in the family and a history of disordered eating and anxiety. Here, we present her case, diagnostic evaluation, ultimate diagnosis, and complications.

Language: en

Keywords

Humans; Female; Adolescent; Risk Assessment; Treatment Outcome; Emergency Service, Hospital; Hemin; Abdominal Pain; Hyponatremia; Constipation; Porphyria, Acute Intermittent; Diet, Reducing; Rare Diseases