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Below is a followup info - but wanted to know from people here on the Liver Disease forum - any ideas?

Hi there. This is a followup....we went to see a peds gastroenterologist on Monday. We were there 2.5 hrs. We went through a lot of information. They asked us A LOT of questions. He ruled out Cyclic Vomiting Syndrome because he doesn't vomit A LOT at one time to the point he gets dehydrated. He even wanted our input as to what it "might" be. He wants to start w/the least invasive testing, that being bloodwork (which he gave on Monday), we have an ultrasound scheduled for the 29th. In between that, he is having us get a sample of his stool and also breathe into some bags for some "gas" test in his gut. By the time the 29th rolls around, they should have all results back for all the tests (except the u/s of course). Now, since Monday, he vomited Monday night, then he vomited once again yesterday (that being because he was upset and crying? cause Daddy dropped him off at G and Grandpa's?). Today he is fine so far. It's 12:20 and I've gotten no phone call from school yet (yay!). This is the 2nd day he has taken his Prevacid (this being a drug we are trying to rule out reflux). So, that's where we're at. One thing that concerned me was looking at his urine testing from September and comparing it to 1/10/07. He had trace ketones on both tests and on the 1/10/07 one had 4mg/dl of urobilinogen which is not good. I e-mailed his regular ped (who referred us) about it and this was his response. I will speak to his peds gastro though abou tthis as well. This is his response 1st, and my actual questions below:

Good questions. Although both tests flagged as abnormal, in isolation, with
other tests normal, I wasn't concerned.
For the urine ketones, it is common to see these positive in children who
have been vomiting. Most individuals will use sugar as their primary source
of fuel. If you don't eat, even briefly, your body then will start breaking
down fat, which creates the ketones. With the results being trace, it more
likely the vomiting causing the ketones than the ketones causing the
vomiting. It would be different, for example, if we saw him spilling sugar
in his urine, with large ketones. That's the presentation for diabetic
ketoacidosis.
The positive urobilinogen is also something I have seen many times in kids
who have been vomiting. If you have slower gut transit time, you have
bilirubin that can be absorbed from the gut and excreted in the urine
(increased enterohepatic circulation). With excessive RBC breakdown, we
would see subsequent anemia. Dawson's hemoglobin is normal. The large
hematoma or bruise would be seen clinically. The liver problems would be
seen in the liver function tests - his bilirubin in the blood was .5, and
his liver function tests were normal.

Although you have a few abnormal tests elevated, they are nonspecific, and
it is often a pattern of tests that show something is wrong. That's why I
wasn't concerned, or thought they meant too much. I still think is a good
idea to point those out to Dr ((((( - two heads are better than one.


Subject: Dawson's Urinalysis

Hi, question for you. I was wondering looking at Dawson's lab reports
comparing from September to the one your ordered on 1/10/07.

It showed Trace Ketones on both - is this a concern? Also, the Sept. report
showed negative urobilinogen and the one on 1/10/07 showed 4 mg/dl - which
is an increase and from what I find indicates a problem. Is this a concern
and something I should point out to Dr. ****next time I see him? I didn't
notice it until today and we saw Dr. *****yesterday so I did not mention it.
According the normal level of the hospital's results are supposed to be
0-1mg/dl. I found this info on the net on what abnormal levels "might"
indicate. We go for more testing on 1/29 and in between stool and h.pylori
testing. Thanks again.

Abnormal urobilinogen values may indicative of
Increased values

overburdening of the liver

excessive RBC breakdown

increased urobilinogen production

re-absorption - a large hematoma

restricted liver function

hepatic infection

poisoning

liver cirrhosis



Thank you.





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