A Boy With Frequent Diarrhea: Differentiating IBS From IBD

Lindsey G. Albenberg, DO; Wenjing Zong, MD

Disclosures

March 18, 2019

Editorial Collaboration

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Case Continued: History, Physical Exam, and Labs

The patient was seen by his pediatric clinician the next day.

He has had a normal appetite and does not report weight loss. He denies fever, mouth sores, nausea, vomiting, dizziness, decreased energy, rashes, joint aches, or headaches. There are no sick contacts.

The patient's medical history is significant only for intermittent asthma. He is not receiving any medications and has no known drug allergies. There is no family history of IBD, celiac disease, IBS, type 1 diabetes, or other autoimmune diseases.

The child lives with his mother, father, and younger sister in a suburban area. He is in the 7th grade and does well in school. He is a competitive swimmer and reports no stress from school. He has not traveled outside of the country.

He is in no acute distress but appears mildly uncomfortable. Blood pressure is within normal limits for patient parameters. His abdomen is soft, with no tenderness to palpation. He has normal bowel sounds and no appreciable hepatosplenomegaly. His stool culture was negative, but hemoccult test was positive. The remainder of physical examination is unremarkable.

Figure 1. Patient's growth chart

Table 1. Laboratory Results and Reference Values

Test Result Reference Range
Sodium 143 136-145 mmol/L
Potassium 3.9 3.8-5.4 mmol/L
Chloride 106 98-106 mmol/L
Carbon dioxide 24 20-26 mmol/L
Urea nitrogen (blood urea nitrogen, BUN) 14 5-17 mg/dL
Creatinine 0.7 0.2-0.5 mg/dL
Glucose 91 70-106 mg/dL
Calcium 9.3 8.8-10.1 mg/dL
Total bilirubin 0.6 0.6-1.4 mg/dL
Total protein 7.1 6.2-8.1 g/dL
Albumin 4.2 3.7-5.6 g/dL
Alkaline phosphatase 298 200-495 U/L
Aspartate aminotransferase (AST) 37 15-40 U/L
Alanine aminotransferase (ALT) 17 10-55 U/L
Gamma glutamyl transferase (GGT) 16 14-37 U/L
C- reactive protein (CRP) <0.5 0-0.9 mg/dL
White blood cell count 5.7 3.84-9.84 THOU/μL
Red blood cell count 5.14 4.5-5.3 MIL/μL
Hemoglobin 14.8 13-16 g/dL
Hematocrit 43.9 37-49%
MCV 85.4 78-98 fL
MCHC 33.7 31-37 g/dL
RDW 38.5 36.7-43.8 fL
Platelet count 270 150-400 THOU/μL
Mean platelet volume 11.4 9.6-11.8 fL
Immature granulocyte 0.2 0-0.3%
Neutrophils 46.3 32.5-74.7%
Eosinophils 2.1 0-4%
Basophils 0.7 0-0.7%
Monocytes 15.4 4.4-12.3%
Lymphocytes 35.3 16.4-52.7%
Sedimentation rate 2 0-20 mm/hour
MCHC, mean cell hemoglobin concentration; MCV, mean corpuscular volume; RDW, red cell distribution width

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