How JustAnswer Works:

  • Ask an Expert
    Experts are full of valuable knowledge and are ready to help with any question. Credentials confirmed by a Fortune 500 verification firm.
  • Get a Professional Answer
    Via email, text message, or notification as you wait on our site.
    Ask follow up questions if you need to.
  • 100% Satisfaction Guarantee
    Rate the answer you receive.

Ask Dr. A. Clark Your Own Question

Dr. A. Clark
Dr. A. Clark, Pediatrician
Category: Pediatrics
Satisfied Customers: 4437
Experience:  33 years of experience as a general pediatrician in private practice and in pediatric urgent care.
17654155
Type Your Pediatrics Question Here...
Dr. A. Clark is online now
A new question is answered every 9 seconds

My son is 4. Every 6-9 weeks he gets sick. He sweats through the night and the vomits ever

Resolved Question:

My son is 4. Every 6-9 weeks he gets sick. He sweats through the night and the vomits everything apart from very small amounts of water. He continues to pee but loses huge amounts of body fluid. His blood is acidotic and he has a mania for water. It lasts 3 days and then he goes back to normal. In between he is completely normal.

He complains his lower back hurts a little before it starts and before he is dehydrated.

It looks like he is poisened and his body is purging something. Kidney related? Please help. We are so tired of going to A&E every tme.
Submitted: 1 year ago.
Category: Pediatrics
Expert:  Dr. A. Clark replied 1 year ago.

Dr. A. Clark :

I'm happy that you have asked me to assist you with your child and hope that you can benefit from my many years of helping parents like you.

Dr. A. Clark :

It sure sounds like he has some issue with his kidneys but other illnesses can affect children like this too.

Dr. A. Clark :

Can you tell me first of all if he has fever when this happens?

Dr. A. Clark :

Also when you say his blood is acid are you referring to a lab test they do at A&E?

Customer: Sometimes. Not an obvious fever though. Yes bloodngas at A&E showed acidosis. Treated with bicarb
Dr. A. Clark :

That is likely just a function of his dehydration and it is very uncommon to give bicarb to children anymore since the real need is IV fluids. Has he ever been evaluated by a kidney specialist (nephrologist)?

Customer: Not yet. They seemed to think his Kidney function was normal because he pees throughout the episodes. If it was Kidney, why would he be completely normal and healthy for the 6-9 weeks between episodes?
Dr. A. Clark :

There are conditions that can appear intermittently that affect kidney function: infections, renal tubular acidosis, etc.

Customer: They gave IV fluids straight away and he gained his shape back but continued to crave water.
Dr. A. Clark :

Have they done liver and kidney function tests on him, blood count, cultures of his blood and urine?

Customer: No but all bloods are at Great Ormond Street now.
Dr. A. Clark :

There is a condition called cyclical vomiting that fits this picture. Have they discussed this with you?

Dr. A. Clark :

Here is a link to information on this:

Customer: They have. It does fit but it doesn't explain the fact he continues to pee while dehydrating does it? Also why the acidosis? Just temporary and due to the dehydration?
Dr. A. Clark :

If he is vomiting he will continue to urinate as long as he is not severely dehydrated but it will slow. Acidosis, which is his case is metabolic, not respiratory, is simply due to excessive vomiting of chloride ions causing what is known as metabolic acidosis due to an imbalance of electrolytes in his blood. Any cause of severe vomiting will lead to acidosis as that is a function of hydration and made worse when vomiting.

Dr. A. Clark :

Any patient who comes in to emergency with dehydration will be acidotic and that is not indicative of any particular disease or cause, much like anemia is just a lab value without a specific origin for low hemoglobin.

Customer: So do you think CVS fits better than say something like RTA?
Customer: To try to rule out acid build up what could we add to his diet? Any suggestions?
Dr. A. Clark :

Yes, much more likely and as you have already read or been told, there is no specific cure as it is time limited anyway.

Customer: Yeah we know there is no cure but hope he grows out of it maybe.
Customer: What about MCAD metabolic disorder? Would thatbfit in your opinion?
Dr. A. Clark :

Again, the acid is not due to some problem with his diet or anything you can prevent. It is simply a lab value indicating the pH balance of his blood is abnormal and hydration, not diet or even bicarb, is the treatment. Here across the pond we rarely use bicarb as it can cause problems. Sometimes we add a buffer to the fluids (potassium hypophosphate) to help slowly increase the pH but rapid correction with bicarb is not done anymore here.

Dr. A. Clark :

MCAD is a fatal disorder when they present with vomiting, shock, acidosis, and eventually total organ failure and unless treated with a special drug (carnitine) they do not improve with just fluids or bicarb. I've treated an entire family with this disorder.

Customer: We have nursed him at home through 2 episodes and never administered carnitine so it appears unlikely it's that.
Dr. A. Clark :

Some of the same treatments for migraine are used for CVS, such as antidepressants, sedatives, etc plus ondansetron (Zofran) given orally as a dissolving tablet or injected. If you don't have that on hand ask your doctor for it as it will help stop the vomiting quickly.

Dr. A. Clark :

I carry Zofran in my pocket when seeing children in our urgent care clinics and pop one in their mouths as soon as I finish examining them to help stop their nausea and vomiting. It is quite safe and effective without side effects.

Customer: Ok. We will try that next time. Do you start taking Zofran when you sense an attack coming? I guess the key is to not allow him to become dehydrated and then see if he recovers faster and avoid the acidosis and subsequent need for further intervention.
Dr. A. Clark :

Yes, give the first dose (4 mg) as soon as you think it is going to start as it takes about 2-5 minutes to be absorbed and another 20-30 minutes to become effective. It can be a lifesaver for parents with children who are vomiting and I never travel without it.

Customer: I think we will also be ultra cautious and request a kidney function test and cultures.
Customer: Ok. Thank you for your help. If you think of anything else then please give me a shout.
Dr. A. Clark :

Great. Please let me know if you have other questions.

Customer: That's it for now. Thanks.
Dr. A. Clark :

I certainly will.

Dr. A. Clark :
Please remember as you exit chat to rate my service as that is the only way experts are compensated for their time! If you feel unsatisfied with my answer at all please don't exit but just hit the REPLY tab and let me know of the issue or question that you have. I will be happy to continue working with you and will do everything I can to provide you with the service you seek and I hope that I can earn an excellent rating from you.

Customer: Bye.
Dr. A. Clark :

Have a good evening and my best to your son and your family.

Dr. A. Clark, Pediatrician
Category: Pediatrics
Satisfied Customers: 4437
Experience: 33 years of experience as a general pediatrician in private practice and in pediatric urgent care.
Dr. A. Clark and other Pediatrics Specialists are ready to help you

JustAnswer in the News:

 
 
 
Ask-a-doc Web sites: If you've got a quick question, you can try to get an answer from sites that say they have various specialists on hand to give quick answers... Justanswer.com.
JustAnswer.com...has seen a spike since October in legal questions from readers about layoffs, unemployment and severance.
Web sites like justanswer.com/legal
...leave nothing to chance.
Traffic on JustAnswer rose 14 percent...and had nearly 400,000 page views in 30 days...inquiries related to stress, high blood pressure, drinking and heart pain jumped 33 percent.
Tory Johnson, GMA Workplace Contributor, discusses work-from-home jobs, such as JustAnswer in which verified Experts answer people’s questions.
I will tell you that...the things you have to go through to be an Expert are quite rigorous.
 
 
 

What Customers are Saying:

 
 
 
  • I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me from a serious, even life threatening situation. I am very grateful to the experts who answered me. Susan O. USA
< Last | Next >
  • I feel so much better today, and upon further investigation believe that there is a chance that the responses I got saved me from a serious, even life threatening situation. I am very grateful to the experts who answered me. Susan O. USA
  • I can go as far as to say it could have resulted in saving my sons life and our entire family now knows what bipolar is and how to assist and understand my most wonderful son, brother and friend to all who loves him dearly. Thank you very much Corrie Moll Pretoria, South Africa
  • I thank-you so much! It really helped to have this information and confirmation. We will watch her carefully and get her in for the examination and US right away if things do not improve. God bless you as well! Claudia Albuquerque, NM
  • Outstanding response time less than 6 minutes. Answered the question professionally and with a great deal of compassion. Kevin Beaverton, OR
  • Suggested diagnosis was what I hoped and will take this info to my doctor's appointment next week.
    I feel better already! Thank you.
    Elanor Tracy, CA
  • Thank you to the Physician who answered my question today. The answer was far more informative than what I got from the Physicians I saw in person for my problem. Julie Lockesburg, AR
  • You have been more help than you know. I seriously don't know what my sisters situation would be today if you had not gone above and beyond just answering my questions. John and Stefanie Tucson, AZ
 
 
 

Meet The Experts:

 
 
 
  • Dr. Yogindra Vasavada

    Pediatrician

    Satisfied Customers:

    2507
    M.D.(ped) passed at first attempt, in practice continuously for last 37 years. Certi. in Comp
< Last | Next >
  • http://ww2.justanswer.com/uploads/DR/Dr. Yogindra Va/2012-6-10_2618_DSC0039.64x64.JPG Dr. Yogindra Vasavada's Avatar

    Dr. Yogindra Vasavada

    Pediatrician

    Satisfied Customers:

    2507
    M.D.(ped) passed at first attempt, in practice continuously for last 37 years. Certi. in Comp
  • http://ww2.justanswer.com/uploads/GA/GauravMD/2012-6-9_62959_gaurav.64x64.JPG Dr. Gupta's Avatar

    Dr. Gupta

    Pediatrician

    Satisfied Customers:

    1442
    MD, practicing Pediatrician with 19 years of experience. Member American Academy of Pediatrics.
  • http://ww2.justanswer.com/uploads/edkulich/2010-08-17_171809_doctor.jpg Dr. K.'s Avatar

    Dr. K.

    Board Certified Pediatrician

    Satisfied Customers:

    819
    Board Certified, Ivy League educated Pediatrician.
  • http://ww2.justanswer.com/uploads/cbellmd/2009-11-19_013247_CB_PHOTO_2.jpg Raymond B., M.D.'s Avatar

    Raymond B., M.D.

    Doctor

    Satisfied Customers:

    422
    I provide medical care for newborns, children, adolescents and young adults up to age 21 years.
  • http://ww2.justanswer.com/uploads/DA/davhill1/2012-6-6_17340_DLHSittingCropped.64x64.jpg David L. Hill, MD, FAAP's Avatar

    David L. Hill, MD, FAAP

    Doctor

    Satisfied Customers:

    414
    Adjunct Assistant Professor of Pediatrics, UNC Medical School. Vice President, Cape Fear Pediatrics.
  • http://ww2.justanswer.com/uploads/josho33/2009-12-16_0435_php4n8fiy_c2PM.jpg Dr. Davidson's Avatar

    Dr. Davidson

    Board Certified Pediatrician

    Satisfied Customers:

    408
    Board Certified Specialist in Pediatrics, Allergy, Asthma & Immunology
  • http://ww2.justanswer.com/uploads/FA/fabiola.caracseghi/2012-4-12_204829_foto2.64x64.JPG Dr.Fabiola.MD's Avatar

    Dr.Fabiola.MD

    Pediatrician

    Satisfied Customers:

    118
    Pediatric Immunology. General Pediatrics
 
 
 
Chat Now With A Pediatrician
Dr. A. Clark
Dr. A. Clark
Medical Director and pediatrician
4289 Satisfied Customers
33 years of experience as a general pediatrician in private practice and in pediatric urgent care.