| Autor: |
Rowley, L, Ali, K, Bursell, J, Waters, N, Aye, M |
| Zdroj: |
Archives of Disease in Childhood; 2018, Vol. 103 Issue: Supplement 1 pA62-A62, 1p |
| Abstrakt: |
BackgroundA seven month old boy with gastro-oesophageal reflux, developmental delay and an inherited genetic abnormality had repeated admissions with vomiting and static weight. He was commenced on nasogastric (NG) feeds as he was found to have an unsafe swallow during an acute viral illness. His mother continued to report poor feed tolerance despite NG and nasojejunal (NJ) feeding.Details of the caseDuring an inpatient stay at a different hospital it was observed that the mother would present ‘well caught’ vomitus to the nursing staff. The baby was not witnessed to be vomiting. In addition, a well secured NJ tube was reported by the mother to have accidentally been dislodged. These safeguarding concerns were shared with the local hospital.On a subsequent admission to the local hospital with reported vomiting the baby was commenced on dioralyte via the NG tube. The mother continued to present ‘vomit’ in a bowl to nursing staff despite minimal nasogastric tube aspirates being observed. One episode raised particular suspicion as to the validity of the mother’s claim.pH indicator strips were used to determine the pH of the fluid which was presented as vomit. This was noted to be 7.5 (similar to tap water). An aspirate obtained from the baby’s NG tube was 4.5, which was similar to the pH of dioralyte.The observed disparity led to initiation of child protection procedures on the basis that there was objective evidence of fabrication of illness.Following separation from his mother the baby went on to tolerate milk feeds and solids with no vomiting. His faltering weight resolved.ConclusionThe use of pH indicator strips in this case confirmed the variance in pH between the gastric aspirate and the fluid presented by the mother as vomit. We propose the use of this simple bedside test in perplexing presentations with reported vomiting. One must remain cautious of the effect of anti-reflux medications on the pH of gastric fluid. It is imperative that the team consider chain of evidence and correct storage of specimens for use at a later date. |
| Databáze: |
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