An 18-Year-Old With Acute-on-Chronic Abdominal Pain.

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  • Additional Information
    • Source:
      Publisher: American Academy of Pediatrics Country of Publication: United States NLM ID: 0376422 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1098-4275 (Electronic) Linking ISSN: 00314005 NLM ISO Abbreviation: Pediatrics Subsets: MEDLINE
    • Publication Information:
      Publication: Elk Grove Village Il : American Academy of Pediatrics
      Original Publication: Springfield, Ill., Thomas.
    • Subject Terms:
      Abdominal Pain/*etiology ; Chronic Pain/*etiology ; Porphyria, Acute Intermittent/*complications ; Porphyria, Acute Intermittent/*diagnosis; Acute Disease ; Adolescent ; Cholecystectomy ; Constipation/etiology ; Diagnosis, Differential ; Female ; Hemin/therapeutic use ; Humans ; Liver/enzymology ; Muscle Weakness/etiology ; Nausea/etiology ; Pancreatitis/diagnosis ; Pancreatitis/surgery ; Paresthesia/etiology ; Porphyria, Acute Intermittent/drug therapy ; Recurrence ; Weight Loss
    • Abstract:
      An 18-year-old woman with a complex past medical history presented with 2 days of vomiting and lower abdominal pain. She had been admitted for the majority of the previous 5 months for recurrent pancreatitis and had undergone a cholecystectomy. Additional symptoms included nausea, anorexia, constipation, and a 40-lb weight loss over 4 months. She appeared uncomfortable, and an examination was remarkable for tachycardia, hypertension, and diffuse abdominal tenderness to light palpation. Her initial laboratory test results revealed mildly elevated liver enzymes (aspartate aminotransferase 68 U/L, alanine aminotransferase 80 U/L) and a normal lipase. She was admitted for pain control and nutritional support. Over the next few days, the lipase increased to 1707 U/L. Despite optimizing her management for acute pancreatitis, the patient's symptoms persisted. Further history gathering and laboratory testing ultimately revealed her diagnosis. Our expert panel reviews her hospital course and elucidates the management of our eventual diagnosis.
      Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
      (Copyright © 2018 by the American Academy of Pediatrics.)
    • Accession Number:
      743LRP9S7N (Hemin)
    • Publication Date:
      Date Created: 20180412 Date Completed: 20190307 Latest Revision: 20190307
    • Publication Date:
      20250114
    • Accession Number:
      10.1542/peds.2017-1332
    • Accession Number:
      29636397