Fever in a Patient with Short Bowel Syndrome

The pediatric short bowel syndrome (SBS) population is growing as the neonatal population grows due to improved perinatal care, and familiarity with SBS is important for pediatric ED physicians and hospitalists. ED providers should be aware that typical symptoms of common childhood illnesses, such as fever, vomiting, and diarrhea, have a broad differential in the SBS patient that necessitates familiarity with the underlying pathophysiology of SBS and a thoughtful interpretation of subtle features. The risk of CLABSI in the PN-dependent SBS population exceeds that of other line-dependent populations and mandates a high index of suspicion for this entity. D-lactic acidosis is a rare finding in patients with SBS due to challenges in measuring D-lactate in most clinical settings, and it requires a high index of clinical suspicion to render a timely diagnosis.