Further blood tests

As you noticed that there were a couple of minor anomalies on the initial blood tests you wonder if these might be connected to the current problem. You repeat the full blood count, the Urea and electolytes, calcium, phosphate, and also add other tests: ferritin, B₁₂ and folate levels, vitamin D and an alkaline phosphatase.

Charlie’s parents are surprised that you are doing these tests, but you explain that there might be a problem with the intestines that is causing both the vomiting and the blood test problems. You also noticed that there was a fracture on the chest xray, and wonder if the bones are a little weak.

The blood tests take a while to come back, but when they do you return to see Charlie again.

Ferritin                                   72 microg/L
Vitamin B₁₂                             550 nanog/L
Folate                                     81 microg/L
Vitamin D                               <10 iU/L
Alkaline phosphatase854 iU/L

You return to tell the parents, but find the arrest team is around the bedspace. The ward sister explains that she continued to deteriorate after you left with two vomits and this had now become greenish, but then suddenly she looked pale and unresponsive.

The arrest team was called but by the time they had arrived she was again looking better. A cannula has been sited and a 10 ml/kg fluid bolus is being given. A venous blood gas has also been taken:

pH                   7.27
pCO₂                    4.8 KPa
pO₂                  5.1 KPa
BE                   -3.5 mmol/L
Lactate            3.1 mmol/L

What would you like to do now?