An 18-Month-Old Boy with Diarrhea and an Elevated Biochemical Parameter

Abstract

A n 18-month-old boy presented to his primary care pediatrician with a complaint of diarrhea for the past 5 days. The diarrhea was frequent, watery, but without mucus or blood. The diarrhea was not associated with vomiting, fever, cough, or skin rash. His past medical history is significant only for mild asthma, and his immunizations are up-to-date.The physical examination revealed an alert, well-developed boy with a weight of 11.9 kg (54th percentile), height of 84.5 cm (77th percentile), and normal vital signs. His abdomen was soft, nontender, and without hepatosplenomegaly or signs of dehydration. The rest of the physical examination was normal.A clinical diagnosis of viral gastroenteritis was made and oral rehydration therapy and dietary modifications were recommended. After 3 days he returned to the clinic because of the persistence of the diarrhea, and there were still no other symptoms. Once again, the results of his physical examination were normal. Because of the continuation of the diarrhea, laboratory tests (blood, urine, and stool) were performed, and the results were as follows: hemoglobin, 11.5 g/dL; white blood cells, 9.2 10 3 /mcL; platelets, 367 10 3 /mcL (with a normal differential count); C-reactive protein, <0.5 mg/dL; glucose, 75 mg/dL; urea, 25 mg/dL; creatinine, 0.20 mg/dL; potassium, 4.3 nmol/L; sodium, 138 nmol/L; protein, 6.2 g/dL; albumin, 4.1 g/dL; bilirubin, 0.20 mg/dL; ferritin, 20 ng/mL; asparate aminotransferase, 37 U/L; alanine aminotransferase, 26 U/L; gamma-glutamyl transpeptidase, 5 U/L; calcium, 9.3 mg/dL; and phosphorus, 4.9 mg/dL. Urinalysis was normal, and stool for culture, ova, parasites, Giardia lamblia antigen, rotavirus, and adenovirus was negative. Blood serology was negative for Epstein-Barr virus (EBV), hepatitis C, and for immunoglobulin M cytomegalovirus (CMV) antibodies, and positive for immunoglobulin G CMV antibodies, indicating a past infection with CMV.An elevated biochemical parameter in the blood revealed a condition that may be associated with the clinical presentation (gastroenteritis) described, appearing mainly in infancy and early childhood.

Benign transient hyperphosphatasemia in children

“…BTH represents a harmless biochemical abnormality that spontaneously disappears within a few months [1][2][3][4][5][6][7][8][9]. It is most commonly found in children under five years of age, usually as an incidental finding during laboratory testing in routine health care, or as part of an evaluation for a specific complaint [2,3,5,10].…”

“…Benign transient hyperphosphatasemia (BTH) is a complex and pathogenetically vague clinical entity expressed by transiently increased serum activity of alkaline phosphatase (ALP) [1][2][3][4][5][6][7]. It occurs in the absence of skeletal, liver, and other diseases characterized by the increase in ALP [2,3,[5][6][7][8][9].…”

“…It is detected by accident either during routine health check or by examining one of the diseases [2,3,[5][6][7][8][9][10]. It is most commonly found in children under five years of age, especially in infants, and rarely later [2][3][4][5][6][7][8][9][10][11][12]. Although seldom, BTH also occurs in adults [13].…”

“…Although seldom, BTH also occurs in adults [13]. Return to normal ALP levels usually occurs within four months, and sometimes a little later [4,[9][10][11][12]. The most common circumstance of its occurrence are various infections, usually viral, and rarely other pathological conditions [1,3,10,14].…”

“…The most common circumstance of its occurrence are various infections, usually viral, and rarely other pathological conditions [1,3,10,14]. Bearing in mind the absence of any negative consequences, BTH is considered a benign biochemical disorder and does not require extensive investigations nor the use of vitamin D or other therapeutic procedures [3,4,8].…”