Vomiting and diarrhea in an infant (210/1700)

A 2 month child with diarrhea and vomiting for 6 days is brought in looking lethargic. What is the
appropriate initial inv?
a. BUE
b. Random blood sugar
c. CBC
d. CXR
e. AXR

answer: A

renal failure is part of the DD for a vomiting infant, here without a fever it will be high on our list of suspicions 

Here, we will mainly introduce common symptoms of elevated BUN.

1. Nausea, vomiting, diarrhea

Nausea or vomiting is a torturous symptom that occurs easily when BUN is elevated. BUN is the abbreviation of blood urea nitrogen which refers to the level of urea nitrogen in blood. Urea nitrogen is the end product of protein. When excessive urea nitrogen cannot be discharged timely, they will build up in the body and stimulate digestive tract, and thus cause nausea or vomiting. In serious cases, patients may vomit blood.

2. Itchy skin

Itchy skin is another annoying symptom that occurs easily when BUN is elevated. As we have mentioned, urea nitrogen is the end product of protein. They can stimulate skin and sebaceous gland, and thus cause atrophy of sweat gland, which can cause dry skin and itchy skin.

3. Tiredness

Kidney disease patients with elevated BUN may find they become tired easily and this is usually caused by renal anemia which is diagnosed when red blood cell account is lower than the normal range due to kidney disease.

4. Foamy urine

Foamy urine is the clinical manifestation of proteinuria. In normal cases, no protein can be detected in urine, however, when kidneys are injured, protein will leak into urine. When proteins get out of patient’s body with other wastes, foams will be formed.

5. High blood pressure

High blood pressure is another symptom that occurs when BUN is elevated.