Question of the week # 301

301) A five month old male infant is brought to the out patient department for evaluation of one month history of recurrent vomiting, diarrhea and skin rash . The baby was delivered normally at term with out any complications. Mother reports that she breastfed him for four months and recently has been feeding him exclusively with formula. Mother reports that the baby vomits intermittently after each feed and develops raised, red welts on his skin after each feeding. There is no blood or bile in the vomitus. Vomiting  occurs within 30 minutes after feeding. Suckling is normal. He also has mucousy, loose stools for the past three weeks with no blood.  There is no history of cough, cold or fever. On examination, the infant in no apparent distress and vitals are normal. Abdominal examination is benign with out any palpable masses or peristaltic waves. Rest of the physical is  normal. Laboratory investigations reveal Hb: 13.2 gm%; Haematocrit: 35%; WBC: 9,200/μl ; Platelets: 225,000/μl, Na 132 meq/L; K 3.8 meq/L; Cl 92 meq/L; albumin 4.6g%. Urinalysis is normal. Which of the following is the most appropriate next step in managing this condition?

A) Abdominal ultrasound

B) Lactose free formula

C) Start hydrolyzed formula feeds

D) IgE Radio-allergosorbent test

E) Observation

19 Responses

  1. hydrolysed formula

  2. Lactose free formula

  3. either c or d

  4. B

  5. lactose free formula…I think

  6. lactose free formula

  7. C; Start hydrolyzed formula feeds

  8. C

  9. i think d

  10. D…….there is some kind of food allergy in this case, so the most important point here, before change the formula to hydrolysed, is to determinate what is causing this allergy. RAST test will be an important next step.

  11. C .

  12. bbb

  13. Ans C

    infant <6 months old . this patient definitely has cow's milk allergy . Present of Eczema and vomitting ever since started formula feeding .

    patient is growing well and no severe distress . A trial of hydrolyzed milk may be beneficial .

    The dilemma is when is RAST test indicated ? Is it indicated only if the infant has severe form likes anaphylaxis ?

    we need your help dr. redz . Thanks

  14. -D
    Before changing diet it’s important to know what is cause of allergy. Radio-allergosorbent looks next best step.

  15. ans


  16. I think C: Cow milk allergy is one of the differential diagnosis. Remove the cause of allergy first and investigate.

  17. B

  18. (C).lctose intolerance does not cause skin rash

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