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Q. My daughter has repeated episodes of vomiting. I would like your opinion on this matter.

Answered by
Dr. Sadaf Mustafa
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Apr 30, 2017 and last reviewed on: Sep 03, 2021

Hello doctor,

Last year my daughter decided to go on an all vegetarian diet rather drastically. A few weeks later, she got ill with vomiting which lasted for approximately two weeks, so we made three visits to the urgent care, where she was treated for gastritis and dehydration. One month later, the same thing occurred, so this time I took her to another doctor who ran blood tests, stool culture, tested for H.pylori and did an ultrasound. The blood tests were normal with the exception of a high CPK and bilirubin reading. The ultrasound results were also normal. And this happened again a couple of months back. This time a CT scan was ordered and some additional blood tests were done, all of which were normal. The only thing that appears consistent with these episodes is that they always occur approximately two weeks before her period is due, except for an episode that occurred this weekend when she did not eat on time. I am rather concerned and would like your opinion on this matter.

#

Hello,

Welcome to icliniq.com.

  • I have two theories here, but I would need a little more information if you would not mind sharing.
  1. Has she ever been tested for G6PD (glucose-6-phosphate dehydrogenase) deficiency?
  2. During these episodes did she get a CBC (complete blood count) done? Was it compared to here baseline? If yes, are there any changes? Was there drop in hemoglobin? Can you share her entire report?
  3. You mentioned her bilirubin was elevated, how high was it? Was it total bilirubin, indirect, or direct? Can you share the report, please?
  4. Same question for CPK (creatine phosphokinase)? Do you have the numbers? Also, how was her kidney function test with the elevated CPK?
  5. Is she overweight?
  6. With these episodes does she have belly pain? If yes, where exactly does it hurt? And what brings it on? Does vomiting relieve it?
  7. Did she ever have a HIDA (hepatobiliary iminodiacetic acid) scan?
  • Sorry to ask so many questions. Just wanted to make sure to guide you in the right way.

Revert with more information to an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician

Thank you doctor,

I am not aware of a test for G6PD deficiency, and I will have to inquire about the CBC. She is underweight in my estimation. I will ask about the kidney function test, but I was advised that those were normal. She does experience a burning pain in her upper abdomen just below her breasts. The vomiting relieves the pain temporarily, but I am not sure what brings it on. I am not aware of an HIDA being done. I was present for the ultrasound, and the technician looked at the gallbladder, liver, kidneys, pancreas, etc. Please see the CPK and bilirubin levels in the attached report.

#

Hello,

Welcome back to icliniq.com.

Thank you for attaching her report (attachment removed to protect patient identity).

  • I was thinking of acalculous cholecystitis, which means having gallbladder pain without stones. This is due to the malfunctioning of the gallbladder. This can be tested through the HIDA scan. 
  • I would not worry about the CPK and bilirubin, both of which are very slightly elevated, and can happen if she is having an acute gallbladder flare.

For more information consult an internal medicine physician online --> https://www.icliniq.com/ask-a-doctor-online/internal-medicine-physician


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