smitha
Forum Elite
Topics: 53
Posts: 236
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A 2 yo old male is brought to the ER by his mother after a bout of vomiting . The child has been seen by ER staff physicians in the past for numerous episodes of vomiting & diarrhea. VS…HR—140/min, BP…100/60, hyporeflexia, muscle weakness & tenderness.
Elytes…..low ser potassium, BUN , CPK, Creatinine normal. ECG…no arrhythmias or conduction disturbances.
Wat is ur diagnosis…………and how in ur opinion did the child land up with this condition????
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| Delusional
Forum Elite
Topics: 41
Posts: 226
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Hey smitha,
Took a break....unwarranted.....sorry about that ....I am back in full effect
Yeah..
this case ....hmmm..
To tell u the truth i don't have much of a clue...
But i wld think one of the follwoing.....
A condition characterized by recurrent GIT upset and that shld result in Hypokalemia
or a condition that causes both from the beginning.... Hypokalemia with voimiting and diarrhea
Or the mother is so cruel she is doing something to that child like giving him some drug or something..... some sort of Factitious disorder by proxy
Am i along a good track here
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| smitha
Forum Elite
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 Hi del!!!!!!! U definitely have come back in full form/effect!
U r ABSOLUTELYYYYYYY on the right track.............
This is a case of "Munchausen's syndrome by proxy" & the pt. is being given "ipecac syrup" for inducing vomiting & the symptoms r produced by it's overdose only.
Chronic ipecac poisoning shud be suspected in cases in which children r repeatedly brought in with symptoms such as these.
Intoxication may result in cardiomyopathy & fatal arrhythmias(as ipecac contains emetine).
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| Delusional
Forum Elite
Topics: 41
Posts: 226
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Thank you ...Smitha
I didn't though say the right Dx .....but i guess i got close......
Nice ....to know that it was Ipecac and the association......won't forget it at all
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| smitha
Forum Elite
Topics: 53
Posts: 236
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ok NOTE..........even a bulimia pt. can present with ipecac overdose/toxicity as she tends to induce vomiting......
And NOTE: bulimia pt.s r also associated with KLEPTOMANIA, as they tend to steal, hide & eat and show that they r not eating..........
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| sunny
Forum Junior
Topics: 4
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Mam, is it ok to not consider hypertrphiic pyloric stenosis of infancy at all? Is it ok to overlook that without a clear lead about ipecac?
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| Medicine Guy
Forum Junior
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any other differentials?? pl
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| mkodumagulla
Forum Senior
Topics: 12
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No Hypertrophic Pyloric stenosis will have a totally different look. First of all Age . It is seen in first born male children around 6 wks of age. Olive sized mass will be palpable. That how we dx Hypertrophic Pyloric Stenosis. Correct me if wrong.
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| omega
Forum Newbie
Topics: 1
Posts: 7
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absolutely true regarding hypertrophic pylorics stenosis, add to this that the child would have a failure to thrive and repetitive almost always post feeding vomiting ( not just recurrent )
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