SOLVED587

Antonio is a 9-year-old boy whose mother brought him to a pediatrician’s office. The family had emigrated to the U.S. from Mexico 10 months earlier. With the aid of an interpreter she explained that Antonio was becoming increasingly upset by his inability to keep up with other boys on his soccer team because of the painful muscle cramps that occurred in his legs with strenuous exercise. He had also been complaining that everyday activities requiring significant muscle effort, such as climbing stairs, caused him pain. She explained further, “He’s had these pains all of his life, but not so bad as now. The doctor in Monterrey told me he probably had liver disease because his urine is red or brown sometimes. But the dark urine always appears after the muscle cramps come. The cramps go away if he rests for a while.” Further questioning revealed that Antonio’s older brother and younger sister were not affected by similar symptoms. Antonio was of normal height and weight for his age, and his vital signs were unremarkable. Muscle size and tone were unremarkable. Mild proximal muscle weakness was present in all extremities and he had difficulty walking on his heels or toes more
SCIENCE
HEALTH SCIENCE
NURSING

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