Mikey was an otherwise healthy baby, but was going through a bout of colic.
Mikey was found unresponsive underwater in a bathtub after his mother suffered a seizure while in the bathtub with him. They were both discovered by Mikey’s father Brent. Mikey was rushed with his mother to Princeton-Plainsboro Teaching Hospital and started breathing again during the ambulance ride.
At the hospital, Mikey was seen by Dr. Chase, who noted Mikey was responsive, if a bit sluggish. He ordered Mikey to be admitted to the Neonatal Intensive Care Unit as a precaution.
However, as Brent came to visit him, Mikey’s oxygen stats suddenly started to drop. Mikey was given oxygen, but Dr. Chase diagnosed the problem as a collapsed lung. He called for an intravenous catheter and used it to pierce the thoracic cavity to allow the lung to re-expand. Mikey’s oxygen stats returned to normal, but Dr. Chase realized there had to be another underlying condition.
Mikey was put on a respirator. Dr. Chase did a chest x-ray and found signs of chemical pneumonitis, most likely from inhaling the soap bubbles in the bathtub. He ordered prednisone and more oxygen. However, Dr. House also saw the x-ray while working on another case and felt that the pneumonitis was bacterial in origin and recommended ECMO. However, Dr. Chase refused because he though the chance of their being bacteria in bath water was very low. Dr. House noted the x-ray showed too much consolidation for chemical pneumonitis. Dr. Chase countered that ECMO was dangerous, but Dr. House countered if it were bacterial, it would soon overwhelm the newborn patient.
Dr. Chase was convinced and explained the procedure and risks to Brent. He explained antibiotics would not work quickly enough. Brent gave consent and they started the treatment.
Mikey was soon well enough to be released from NICU. Brent took him to visit Kara. However, when he left them alone, Kara started to suffocate the baby. She was interrupted by Dr. House and Dr. Foreman. Dr. House noted there were no breath sounds and started artificial respiration after calling for a crash cart and epinephrine.
Mikey was soon stabilized, but the lack of oxygen had caused kidney damage. Mikey’s potassium continued to climb, causing an irregular heartbeat. Dr. Chase started dialysis and warned Brent that if they couldn’t get Mikey’s potassium down, he would most likely suffer a heart attack.
Dr. Chase returned to Dr. House’s team and started discussing the treatment protocols to try to reduce Mikey’s potassium levels. Dr. Chase was treating with polystyrene, and even increased the dose when the initial dose was ineffective. Dr. House realized something and ran out of the room.
Dr. House asked Brent for permission to do an autopsy on Mikey because Kara would suffer severe bleeding if she had a biopsy on her small intestine. Brent resisted, but eventually gave in. Dr. House ordered Dr. Chase to do the biopsy on Mikey. Dr. Chase did so and saw that Mikey’s intestinal vilii were atrophied - a symptom of Celiac disease. Although Mikey was not on solid food, the NICU used wheat gluten to bind the polystyrene. The reason the polystyrene was ineffective was that Mikey‘s intestines were too damaged to absorb it. He didn’t have colic at all, just symptoms of Celiac. They realized Kara had Celiac as well.