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

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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.

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.

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