~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ This message is from PedTalk! To reply to the group, use "" ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Guess what I saw last week.- A 12 yr. old healthy boy came into the ER after having had 5 grossly bloody bowel movements-- mostly blood, minimal formed stool. He did not appear sick and complained only of a mild headache. Hb on adm. was 12.9 and the rest of the CBC, SMA7 UA, ESR were normal. PT/PTT were mildly prolonged. The amount of blood was pretty impressive and his PE was normal. He was kept in observation for serial H/H and continued to have blood per rectum that night with minimal to no cramping. Barium enema was normal and Meckels scan was scheduled but it was screwed up because they did the BE first and had to wait for the barium to evacuate. Stool cultures were sent on admission. The child was started on cefotaxime and Flagyl while awaiting cultures but he never gave me the impression that he had an infectious colitis. The next part of the history I hate to tell lest y'all think we're all a bunch of Rednecks in East Texas but it is important. 24 hrs prior to admission the child drankl "1 to 2 inches out of a gallon jug of homemade moonshine whiskey that his granddad had just brewed and offered. The child says he got drunk but did not retch or vomit (no, the parents did not know and yes they are mighty upset with gramps who that same day was admitted in DKA). Because of this Hx - which I didn't know about until 24 hrs. post admission, I also started him on a Zantac drip thinking that what I suspected to be a lower GI bleed was actually alcoholic gastritis. I called Poison Control about the moonshine but they said to treat it as a regular ethanol ingestion. The headache disappeared-- I guess he was hung over. He had no further blood per rectum or stools after 24 hrs of admission. His Hb dropped 3 grams during admission to a low of 9.2/26. The stool culture quickly grew E Coli 157:OH. Sensitive to everything. I could not prove hemolysis and his Creatinine and platelets were always normal. He was asymptomatic and did not appear to need a transfusion so I sent him home after the nurses got tired of him popping wheelies in the wheel chair. His Hb today was up to 10. Weird case- I guess it was E Coli hemorragic colitis but he never had any cramping, fever or actual diarrhea. I never did the Meckels scan- I sort of left it up in the air that if he started bleeding again we'd do it. What do you think? Thanks-- Kim Burlingham, MD