A Fifteen Year Old Vomiting Blood

3/12/2008

I was asked to see a 15 year old young man yesterday who has had a fever, vomiting and occasional chills. He also reports a cough of several days duration. On the day of the visit he noticed a significant amount of blood in the vomited material. The blood was bright red.

On examination he was noted to be sweaty, slightly pale and breathing comfortably. He had a very normal chest exam with equal breath sounds on both sides of his lungs. I performed a clinical blood count (CBC) in the office in view of the chills and the bloody vomiting. The white blood cell count was elevated with a predominance of bacterial type cells (neutrophils). There was no anemia present. I ordered a chest x-ray which revealed a lobar (bacterial) pneumonia. The reason for the blood test and x-ray has much to do with the chills that were reported. In this age group as with adults, chills are often a sign of a bacterial type infection.

The pneumonia was treated with Amoxicillin, an oral antibiotic. I also advised an old fashioned medication called Carafate which coats the esophagus and stomach where bleeding occurs. Some children and teens can vomit very forcefully and cause a significant amount of bleeding usually from the junction of the lower esophagus and upper stomach. The bleeding in this case was very self limited and stopped almost immediately. The Carafate liquid will be used for several days until the infection and nausea resolve. This type of bleeding with vomiting is called hematemesis. If the vomiting of blood persisted, then a further evaluation would have been indicated to make sure that a bleeding ulcer in the stomach was not the cause.

The young man was also advised to take a course of probiotics for a period of several weeks to protect and repopulate his gastrointestinal tract following a course of antibiotics.

      

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