Patient is an 8 year-old female with HPN dependence due to short bowel syndrome. She has high ostomy due to proximal stoma. Height velocity gradually slows over the last 12 months. Receiving adequate calorie and fluid support. Compliance has been assessed to be satisfactory. On history, parents report she especially craves pickles and French fries (salty foods).
What's the next step?
A. Increase parenteral nutrition calories.
B. Reassurance that patient is undergoing pubertal growth spurt.
C. Check serum and urine electrolytes. Consider increasing PN sodium provision.
D. Refer to the local emergency department for bacteremia work-up.
E. Check liver ultrasound.