A 14-Year-Old Boy with Vomiting

Abstract

A 14-year-old boy was transferred from an outside hospital for evaluation of vomiting. He had been well until he traveled to India 3 weeks earlier. Upon return, he developed abdominal pain and recurrent episodes of nonbilious, nonbloody emesis. The day of admission, he ate a slice of pizza and then experienced numerous episodes of vomiting every 15 to 30 minutes. There had been minimal diarrhea at the beginning of the illness, but none over the following 3 weeks. Review of systems was otherwise unremarkable. The patient’s medical history was remarkable for poor weight gain and linear growth without any evaluation. He is in an eighth-grade classroom, but functions at a first-grade level. His parents are aware that his IQ is low, but they can’t describe the extent of his cognitive impairment. All we know of his developmental/intellectual history is that he walked at 2 years of age and spoke his first words at 3 years. The family follows a traditional Jain vegetarian diet (in this case, essentially vegan). They had given him Ensure in the past because of his poor weight gain. The family history is unremarkable. He has one healthy brother of normal stature. There is no known history of consanguinity. Birth history was unremarkable. On exam, the patient was a small, thin, malnourished boy. He was afebrile, pulse 82, respiratory rate 20, and blood pressure 112/70. His height was