Pediatrics/Abnormal labs/ chronic complaints
My son is 8 yrs old and has chronic complaints of stomach aches almost everyday. He almost always complains of his stomach hurting during or after meals, but also complains of this before meals sometimes. He has mostly normal BMs with occasional constipation. No blood noted in stools. No vomiting. He also complains of feeling abnormally tired most of the time. He complains almost everyday of neck/back/arm/and/or leg pains. When wrestling with his sister, falling down, or getting very minor injuries he seems to be in more pain than he should be. (Just FYI, I have Fibromyalgia). His muscles seem to be a little weaker than other boys his age when playing sports/swimming. But in the MD office had a normal (quick) neuro exam. All of these symptoms have been going on for at least 1 year. He has had no fevers. He has had no major injuries, no abnormal bruising. He is tall and slender (over the 95% for height and weight).
His MD ran labs with the following results:
*Carbon Dioxide 29
Anion gap 11
*BUN/Creatinine ratio 34.0
Osmolality, calculated 282
Total Bilirubin 0.3
Total Protein 6.5
*A/G Ratio 2.3
Alkaline Phos 348
Free Thyroxine 1.27
Hemoglobin 13.3 (He takes multivitamins with Iron qd)
(He ate oatmeal and drank milk about 2h prior to labs being drawn).
Can you tell me what may be the possible causes of the borderline and abnormal lab results and what further testing he should have done? Are there any s/s I should be monitoring? Do any of the lab results seem to be a cause for his s/s mentioned above?
The abnormal labs have no pediatric significance and are ratios we don't even bother checking. All these labs are normal. I find no evidence in the labs that explain his symptoms. His symptoms are hard to pin down and could range from depression to a number of medical issues, most of which would be found by a good history, an exam, and labs. I don't know what he has. Getting into the world of pediatric fibromyalgia is tricky territory, and probably is in the realm of a good peds rheumatologist.
Good luck, Dr. Olson