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(Pediatrics in Review. 2006;27:271-277.)
© 2006 American Academy of Pediatrics

Index of Suspicion

The first 300 words of the full text of this article appear below.

	Case 1 Presentation

 
An 18-month-old girl is brought to the ED for several episodes of nonbilious vomiting that started 1 hour before the visit. Her mother denies rhinorrhea, fever, cough, or trauma, although the girl has been crying more than usual. She passed a normal bowel movement just before arriving. No one is ill at home. The child was born at 29 weeks’ gestation, but did well in the nursery and has been healthy except for a few episodes of wheezing. She takes no medications, has no allergies, and is fully immunized. Her parents are sure there has been no toxic ingestion.

The girl appears lethargic, pale, and weak but has no focal neurologic abnormalities. Her temperature is 97.1°F (36.2°C), heart rate is 140 beats/min, respiratory rate is 26 breaths/min, and blood pressure is 122/63 mm Hg. Her mucous membranes are slightly dry, and she has decreased bowel sounds but no abdominal masses. Stool examination is negative for blood. There are no petechiae on her skin.

Her glucose level, measured by stick, is 113 mg/dL (6.3 mmol/L). Her WBC count is 20.9x10³/mcL (20.9x10⁹/L) with a left shift. Her platelet count is 427x10³/mcL (427x10⁹/L) and Hgb level is 10.5 g/dL (105 g/L). Her electrolyte concentrations are normal except for a bicarbonate level of 19 mEq/L (19 mmol/L), BUN is 12 mg/dL (4.3 mmol/L), and creatinine level is 0.3 mg/dL (26.5 mcmol/L). Urinalysis shows a specific gravity of 1.020 and large ketones. Her vomiting persists even after intravenous hydration. A repeat guaiac examination is positive several hours later, and an abdominal radiograph is ordered that leads to the diagnosis.

	Case 2 Presentation

 
An 11-year-old girl is admitted to the hospital because of sudden, sharp, left upper quadrant (LUQ) abdominal pain, nausea, and vomiting. She has no . . . [Full Text of this Article]

Raemma Paredes Luck, MD
Temple University Children’s Medical Center, Philadelphia, Pa

Léon Maggiori, MD
Olivier Poujade, MD
Toufic Ata, MD
Elie Chouillard, MD
Center Hospitalier Intercommunal, Poissy, France

Jorge Sales Marques, MD
Ana Garrido, MD
Marta Vila Real, MD
Helena Santos, MD
Serviço de Pediatria Centro Hospitalar Vila Nova Gaia, Portugal

Silvia Álvares, MD
Hospital de Crianças Maria Pia, Portugal

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