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When the penny dropped…
  1. Andy Hall1,
  2. Neal Russell2
  1. 1Department of Otolaryngology, Queens Hospital, Romford, Essex, UK
  2. 2Department of Emergency Medicine, Queens Hospital, Romford, Essex, UK
  1. Correspondence to Andy Hall, Department of Otolaryngology, Queens Hospital, Rom Valley Way, Romford, Essex RM7 0AG, UK; Andyhall07{at}

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A 4-year-old girl attended the emergency department (ED) vomiting undigested food with associated weight loss. She had attended ED twice over 3 months but was discharged after tolerating oral fluid challenges. Subsequently she was awaiting an outpatient paediatric appointment for investigation of possible reflux disease.

On examination she was severely wasted, weighing 10.4 kg, below the …

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  • Contributors AH and NR conceived and compiled the article jointly. AH acts as a guarantor.

  • Competing interests None.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; internally peer reviewed.