Lucy is a 4-month-old female with no significant medical history, seen by you for the first time for poor growth. Lucy was breastfed exclusively until 4 months of age and then maintained on a...

Lucy is a 4-month-old female with no significant medical history, seen by you for the first time for poor growth. Lucy was breastfed exclusively until 4 months of age and then maintained on a combination of breast milk and infant formula. Her parents report that Lucy is very eager to feed and appears interested; however, she fails to gain weight. They notice that she sweats a significant amount. They are also concerned with her increasing stool pattern, which is foul smelling and appears greasy. Mom and Dad both work. Lucy has an older brother age 3 years. They have support from extended family. Lucy’s grandmother takes care of Lucy and is also present for the visit. Lucy’s grandmother mentions that when she kisses Lucy, she has a salty taste to her skin.

 Anthropometrics:

 Length 59.5 cm (23.4) Weight 5.0 kg (11 lbs) Weight History Age (months) Weight kg (lbs) Length cm (in) Birth 3.4 (7) 52 (20.5) 1 month 4 (8.8) 55 (21.7) 2 months 4.8 (10.6) 57 (22.4) 3 months 5.0 (11) 58 (22.8)

Biochemical Data:

 Sodium 123 (135-145 mEq/L) Blood urea nitrogen 25 (6-24 mg/dL) Potassium 2.9 (3.6-5.0 mEq/L) Creatinine 1.8 (0.4-1.3 mg/dL) Chloride 73 (98-110 mEq/L) Glucose 78 (70-139 mg/dL) Carbon dioxide 22 (20-30 mEq/L)

Clinical Data:

 Past Medical History: None Medications: None Vitals Signs: Normal Nutrition-focused Physical Exams: Lucy is alert but appears distressed. When you observe her, she has a productive cough during the visit.

1. Describe Lucy’s growth pattern.

 2. How would you assess her nutritional status?

3. What additional biochemical measures would you request?