2 yo w/ watery, nonbloody diarrhea, cyclic vomiting for 3 wks. bact stool cultures neg, o&p neg, eos 16% (absolute 1800). parasites? what next dx/tx?

You may be surprised to know: That cyclic vomiting is a form of dysfunction of the autonomic nervous system. You may find that a supplement of thiamine and magnesium may help. They work in the brainstem and limbic system where the controls of the inflammatory reflex operate through the vagus nerve.

GI workup: It is important to definitively rule out parasitic infection, but eosinophilic inflammation of the GI tract from the esophagus to the colon should be considered. A tissue biopsy and endoscopy will help to establish the diagnosis.

If continuing w/u: any history (specifically infection/fever, rash, wheezing, neuropathy or endocrine)? m or f? rest of diff normal? aec of 1800 worthy of immunology c/s. begin: Ig levels, r/o w/ o/p x3. lft/renal/lipase. parasite serologies (strongyloid, toxocara, trichinella, schisto). cxr. agree with endoscopy.

Pediatric Diarrhea: sounds like your next step is GI workup with endoscopy for sure.

GI specialist: It sounds like more of a GI workup is needed, possibly an endoscopy/biopsy. Perhaps other labs (not sure what bloodwork was done besides CBC with diff).

Eosinophilic colitis: As part of eosinophilic gastrointestinal disorders should be considered. Careful diet review should help in that regard. Repeating stool for ova and parasites at least 2 more times may help, too. I am not seeing kids, so I cannot comment based on my clinical experience.

Think outside GI box: If the obvious GI suspects that should cause these symptoms are simply not there perhaps consider a few zebras such as GI AVM's of the portal vein, autonomic dysautonomia of the GI tract due to dysfunction of the myenteric plexus, and then, there is the often overlooked major symptom of dysautonomia in children and toddlers of pediatric migraine. May attempt erythromycin PLUS propranolol.

Food allergy?: With eos. 16% and o&p negative is it possible that the child might be allergic to something he/she is consuming? Is there a specific food that the child is eating that is causing cyclic vomiting? How about milk/glutane intolarance? It will be good idea to test for these if not already done.