6 month-old female with chronic parenteral nutrition dependence secondary to microvillus inclusion disease presents for routine outpatient visit. History notable for increased stool output after exposure to older sibling with rotavirus. Physical exam is notable for decreased weight, lung sounds clear, no edema exam, no signs or symptoms of heart failure.
Labs:
|
Detail
|
Value
|
Normal
|
Flag
|
|
Sodium
|
130 mmol/L
|
135-148 | Low |
|
Potassium
|
3.3 mmol/L
|
3.20-4.50 | |
|
Chloride
|
95 mmol/L
|
96-109 | Low |
|
Bicarbonate
|
15 mmol/L
|
22-30 | Low |
|
Blood urea nitrogen
|
30 mg/dL
|
7-18 | High |
|
Creatinine
|
0.9 mg/dL
|
0.5-1.2 | |
|
Glucose
|
90 mg/dL
|
66-199 | |
|
Calcium
|
12.5 mg/dL
|
8.4-10.5 | High |
|
Magnesium
|
2 mg/dL
|
1.6-2.6 | |
|
Phosphate
|
4.5 mg/dL
|
2.7-4.9 |
What is the most likely explanation for his labs:
A. Vitamin D deficiency
B. Dehydration
C. Vitamin A toxicity
D. Volume overload
E. Adrenal insufficiency