• Robert S. Holzman
  • Thomas J. Mancuso
  • Navil F. Sethna
  • James A. DiNardo


An 8-year-old girl, 22 kg, previously healthy, presents with diffuse abdominal pain most pronounced in the right lower quadrant, lethargy, weakness, and recent weight loss. She is mildly febrile (100.7°F), with a blood pressure of 80/60 mmHg, a heart rate of 140 bpm, and a respiratory rate of 46/min. She is nauseous and has vomited twice in the ED and several times at home over the preceding few hours. She has a “strange” odor to her breath. Her urine is dipstick + for glucose and ketones.You are called to the emergency room to evaluate her in preparation for appendectomy.


Metabolic Acidosis Cerebral Edema Diabetic Ketoacidosis Congenital Hypothyroidism Mediastinal Mass 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Robert S. Holzman
    • 1
  • Thomas J. Mancuso
    • 1
  • Navil F. Sethna
    • 1
  • James A. DiNardo
    • 1
  1. 1.Children’s Hospital BostonHarvard Medical SchoolBostonUSA

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