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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:
Sodium         141
Potassium      4.2
Chloride       101.5
*Carbon Dioxide   29
Anion gap      11
BUN          17.0
Creatinine     0.5
eGFR          >59
*BUN/Creatinine ratio    34.0
Glucose         91
Osmolality, calculated     282
Calcium         9.7
Total Bilirubin   0.3
AST          29
ALT          18
Total Protein   6.5
Albumin         4.5
Globulin        2.0
*A/G Ratio      2.3
Alkaline Phos   348
Free Thyroxine  1.27
TSH          1.92
WBC          5.4
RBC          4.93
Hemoglobin      13.3      (He takes multivitamins with Iron qd)
Hematocrit      39.2
*MCV          79.5
MCH          27.1
MCHC          34.0
RDW          12.6
Platelets       223
MPV          7.2
Neutrophils     33.1
Lymphocytes     55.6
Monocytes       4.7
Eosinophils     3.1
Basophils       0.4
Neutrophils     1.8
Lymphocytes     3.0
Monocytes       0.3
Eosinophils     0.2
Basophils       0.0
ESR          0

(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?

Thank you,
Jackie

Answer
Hi, Jackie,

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

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David Olson, MD

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I would be happy to attempt to answer any questions about general pediatric topics, either medical issues or behavioral issues. This would include all the various questions one receives in a busy pediatric practice. I`m a board certified pediatrician in northern Michigan and have been in practice for over 15 years. I enjoy the teaching role I have in our practice and would enjoy the opportunity to help others with their pediatric problems.

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