Theo is a 12-month-old patient who is brought to the emergency department by their father for dark-colored urine. The father states that their entire family recently moved from Greece to the United States. they state that, for the past “month or so,” Theo’s urine has been very dark and has gotten darker over time. The father feels that Theo’s lips are really pale and their “belly keeps getting bigger.” The father complains that Theo cries constantly and that nothing seems to make them rest comfortably. They have tried different formulas and foods, but nothing seems to help Theo be comfortable or stop crying.
Upon further questioning, Theo’s father also admits they cannot seem to get Theo to gain weight even with constant feedings. Theo’s father also reports that Theo had “several infections” of different types that “never seem to really go away.” Upon further reflection, the father feels that Theo has been generally “sick” for four or five months. Theo is their first child, was born at term, and Theo’s mother reportedly had appropriate prenatal care.