{"doi":"10.1111/jpc.16424","title":"An unexpected cause of weight loss in a teenaged girl","abstract":"A 13-year-old girl presented to an Emergency Department with generalised weakness and abdominal pain.She is found to have hyponatraemia and significant weight loss (11 kg in 8 months) and she is admitted for further evaluation and treatment.The patient's mother reports that the patient has become an increasingly picky eater over the last 2 years, preferring to eat salty and crunchy foods.Six months ago, she developed abdominal discomfort with meals that led to her eating smaller volumes.She was prescribed a proton pump inhibitor for presumed gastritis, but her symptoms did not resolve.She continues to have intermittent generalised abdominal pain.In the week prior to her presentation, she has eaten almost nothing but continues drinking fluids.She has not had diarrhoea, constipation, nausea or emesis.She denies attempting to lose weight or concerns about her body image.She has no significant past medical history.Laboratory evaluation prior to transfer is significant for sodium of 124 mEq/L (reference range 135-145 mEq/L (135-145 mmol/L)) and C-reactive protein (CRP) level 29 mg/dL (reference range, <0.5 mg/dL (<5 mg/L)).She had sinus tachycardia to 180 beats/min that improved to 140 beats/min with 2000 mL of crystalloid fluid.Physical exam upon arrival reveals an adolescent girl in no acute distress.Vital signs include a temperature of 37 C, heart rate 140 beats/min, blood pressure 132/86 mmHg and respiratory rate 22 breaths/min.Her weight is 43.2 kg, down from 54.9 kg 8 months prior.BMI is 19.5 kg/m 2 .She has mild abdominal distention and diffuse tenderness to palpation.There is no organomegaly, guarding or referred pain.Her cardiovascular and respiratory exams are normal.Her extremities are warm and well-perfused, without oedema or pallor.Initial laboratory evaluation shows the following (reference ranges): white blood cell count 9.9 10 9 /L (4.0-11.0 10 9 /L (4000-11 000/ L)), haemoglobin 9.1 g/dL (11.7-15.7 g/dL (117-157 g/L)), haematocrit level 30.6% (35.0-37.0%),platelet count 534 10 3 /L (150-400 10 3 /L (150-400 10 9 /L)), mean cellular volume 61.0 fl (82.0-98.0fl), RDW 21.3% (11.5-14.5%),sodium 127 mEq/L (135-145 mEq/L (135-145 mmol/L)), potassium 3.8 mEq/L (3.5-5.5 mEq/L (3.5-5.5 mmol/L)), chloride 89 mEq/L (98-107 mEq/L (98-107 mmol/L)), bicarbonate 24 mEq/L (22-29 mEq/L (22-29 mmol/L)), blood urea nitrogen 14 mg/dL (5-18 mg/dL (0.83-3.00 mmol/L)), creatinine 0.36 mg/dL (0.46-0.77mg/dL (40.66-68.06mol/L)), ferritin 80.4 mg/mL (13-150 ng/mL (13-150 g/L)), total iron 7 g/dL (37-145 g/dL (6.63-25.96mol/L)), total iron binding capacity 220 g/dL (250-425 g/dL (44.77-76.10mol/L)), transferrin saturation 3% (27-44%), CRP 23.1 mg/dL (<0.5 mg/dL (<5 mg/L)).An abdominal ultrasound shows abdominal ascites with dilated bowel loops and wall thickening.","journal":"Journal of Paediatrics and Child Health","year":2023,"id":386194,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9532,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1064465,"name":"Neha S. Joshi","orcid":"0000-0003-2397-1662","position":1,"is_corresponding":false},{"id":1154803,"name":"Gabriel Tse","orcid":null,"position":2,"is_corresponding":false},{"id":1154472,"name":"E Dong","orcid":"0000-0001-8122-8012","position":0,"is_corresponding":true}],"reference_count":11,"raw_metadata":null,"created_at":"2026-07-19T01:17:56.803401Z","pmid":"37171150","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}