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Posted On : 30 Aug 2014

i have one pt of vomiting on and off since one month, pt 2 mths old ,anti emetic tried,no sepsis,pyloric stenosis ,obstruction ruled out.cxr -nad.not gaining weigh well,what r the probable diagnosis, what work up should be done

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It is important to chart growth chart on ths patient and exactly know degree of failure to thrive. And also note developmenal abnormality if any. No antiemetic would ever work for any vomiting in general and I am not surprised. Feeding error is the commonest cause of vomiting in such an infant. Detailed history of feeding is vital. Only when you have looked into these issues and find no relevant cause, then only think of inborn error of metabolism. If you think of IEM, then order blood sugar, ammonia and ABG. This would give you a clue to probable IEM. But do not rush into these tests unless you have looked into simple and more common problems that may not be proved by laboratory tests but solved by detailed history and thorough physical examination.

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