Patel Aashka, Sodhani Shreya, Pierre Louisdon, Adeyinka Adebayo, Kondamudi Noah
Pediatrics, The Brooklyn Hospital Center, New York, USA.
Pediatric Critical Care Medicine, The Brooklyn Hospital Center, New York, USA.
Cureus. 2023 Jun 26;15(6):e40973. doi: 10.7759/cureus.40973. eCollection 2023 Jun.
We present a 22-day-old male born full term who presented with worsening non-projectile, non-bilious vomiting and failure to thrive (FTT) and was admitted to the pediatric intensive care unit (PICU) for severe metabolic acidosis with an elevated anion gap. Despite changing the formula, the patient continued to have spit-ups after feeds since birth. Before this admission, his vomiting worsened with every feed, which was now forceful along with two days of loose stools. Obstructive causes of emesis were ruled out with an upper gastrointestinal series, and a decision was made to evaluate for organic causes of FTT. Transient resolution of symptoms was noticed when the patient was placed NPO (nothing by os/mouth) briefly. His symptoms returned on resuming cow milk-based formula feeds. At this time, a presumptive diagnosis of cow milk protein allergy (CMPA) was made. Positive fecal occult blood supported the diagnosis, and his formula was changed to an extensively hydrolyzed formula (eHF). This is a case of severe CMPA with prolonged vomiting and FTT presenting with severe metabolic acidosis with an elevated anion gap. This case report highlights how CMPA can lead to severe dehydration with metabolic acidosis and increased anion gap.
我们报告一名22日龄足月男婴，出现进行性加重的非喷射性、非胆汁性呕吐及生长发育迟缓（FTT），因严重代谢性酸中毒伴阴离子间隙升高入住儿科重症监护病房（PICU）。尽管更换了配方奶，但该患者自出生后喂养后仍持续吐奶。此次入院前，他每次喂养后呕吐加重，现呈强力呕吐，并伴有两天的稀便。上消化道造影排除了呕吐的梗阻性原因，并决定评估FTT的器质性病因。当患者短暂禁食（经口禁食）时，症状出现短暂缓解。恢复基于牛奶的配方奶喂养后，症状复发。此时，初步诊断为牛奶蛋白过敏（CMPA）。粪便潜血阳性支持该诊断，其配方奶改为深度水解配方奶（eHF）。这是一例严重CMPA病例，伴有长期呕吐和FTT，并出现严重代谢性酸中毒伴阴离子间隙升高。本病例报告强调了CMPA如何导致严重脱水伴代谢性酸中毒及阴离子间隙增加。
