What is the role of lab tests in the workup of cyclic vomiting syndrome?

Answer

In the evaluation of the patient for possible GI disease, screening blood work should include a complete blood count (CBC) with differential, assessment of the erythrocyte sedimentation rate (ESR), and measurement of levels of hepatic transaminases, pancreatic amylase, and lipase. Nonanatomic renal disease can be detected by means of serum blood urea nitrogen (BUN) and creatinine tests, urinalysis, and urine calcium-to-creatinine ratio.^[48]

Screening for multiple metabolic and endocrine disorders can be accomplished by assessing pH and measuring levels of electrolytes, glucose, lactic acid, ammonia, amino acids, adrenocorticotropic hormone (ACTH), and antidiuretic hormone (ADH).

Urinary ketones, organic acids, ester-to-free carnitine ratio, porphobilinogen, and aminolevulinic acid may also guide diagnosis in the correct direction.^[48]These metabolic and endocrine tests must be obtained during the vomiting episode to detect intermittent disorders (eg, disorder of fatty acid oxidation) or heterozygote disorders (eg, partial ornithine transcarbamylase deficiency).

All blood and urine tests must be performed before the administration of intravenous (IV) fluids containing glucose or other medical treatments.

In a postmenarchal girl, the physician must consider a beta human chorionic gonadotropin (beta-hCG) test for pregnancy.^[48]

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Media Gallery

Cyclic versus chronic temporal patterns of recurrent vomiting. Number of emeses is plotted over 2-month period. Chronic pattern, represented by thin dashed line, has low grade on nearly daily basis (eg, gastroesophageal reflux). Cyclic pattern, represented by heavy solid line, involves high-intensity episodes intermittently once every several weeks (eg, cyclic vomiting syndrome).

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Author

Thangam Venkatesan, MD Associate Professor of Medicine, Fellowship Director, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical College of Wisconsin

Thangam Venkatesan, MD is a member of the following medical societies: American Gastroenterological Association, Indian Medical Association

Disclosure: Nothing to disclose.

Coauthor(s)

B UK Li, MD Professor of Pediatrics, Division of Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin; Attending Gastroenterologist, Director, Cyclic Vomiting Program, Children’s Hospital of Wisconsin

B UK Li, MD is a member of the following medical societies: Alpha Omega Alpha, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition

Disclosure: Nothing to disclose.

Chief Editor

Carmen Cuffari, MD Associate Professor, Department of Pediatrics, Division of Gastroenterology/Nutrition, Johns Hopkins University School of Medicine

Carmen Cuffari, MD is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, North American Society for Pediatric Gastroenterology, Hepatology and Nutrition, Royal College of Physicians and Surgeons of Canada

Disclosure: Received honoraria from Prometheus Laboratories for speaking and teaching; Received honoraria from Abbott Nutritionals for speaking and teaching. for: Abbott Nutritional, Abbvie, speakers' bureau.

Acknowledgements

Jayant Deodhar, MD Associate Professor in Pediatrics, BJ Medical College, India; Honorary Consultant, Departments of Pediatrics and Neonatology, King Edward Memorial Hospital, India