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Welcome to the Warehouse

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Welcome to the Warehouse is case #15 in House M.D. - Critical Cases.

His parents find Tommy Francis, 16, in an abandoned warehouse.  After he reacts to their presence by calling them demons, they call emergency services.  When he arrives at the hospital, he is filthy, covered in lice and clearly delusional.  The case is assigned to Dr. House.

House's team is confused by the patient's lack of medical records or even a birth certificate.  Robert Chase thinks Tommy is a teenage runaway, but House explains that Tommy is a prodigy who has already completed university and that his medical records are still in his native England.  His parents came to the States to find him after they lost contact with him.  

All of a sudden, Tommy's girlfriend Emma appears and insists that Tommy has never used drugs despite what his parents are saying.

House figures the warehouse is the best place to start and orders an environmental scan.  The team finds a loaf of moldy bread.  After using $1,000 of budget, 5 syringes and 3 ward favors, they confirm the bread is contaminated with ergot fungus.  This points to an environmental cause and rules out encephalitis.

A further environmental scan using only sillouettes finds an energy drink.  After using 3 ward favors, 20 head mdes and 5 thermometers, analysis shows many substances in it but not the most common one that causes adverse reactions - metoclopramide.

A last environmental scan using flashlights in the dark finds a odd smelling substance in the recycling bin.  After using $1,050 of the budget and six tongue depressors, they realize the substance is Tommy's urine and they find traces of blood.  This rules out fibromyalgia.

House treats for ergot poisoning with 22 digestive meds and 3 ward favors.  However, when they return to the room, Emma is arguing with Tommy's parents insisting that he doesn't use drugs.  Tommy's skin starts peeling, but he's still delusional.

Tommy goes code blue and needs to be defibrillated.

House orders imaging and find that Tommy's thyroid gland is enlarged.  After using $1,000 of budget, 7 gauze and 4 ward favors, they rule out Graves' disease.

A further round of imaging shows untreated asthma.  After using 2 ward favors, 6 body meds and 9 IV bags, they realize this rules out influenza.

More imaging shows dilated pupils, a sign of stimulated brain activity.  After using $1,050 of the budget, 4 ward favours and 24 head meds, they realize that this rules out ergot poisoning.

More imaging shows kidney stones.  After using 8 IV bags and 24 chem meds, they realize this rules out choledocholithiasis.

House decides to treat for meningitis with 8 syringes and 28 body meds. He becomes angry when Chase knows that Emma is a drug abuser, because drugs would explain Tommy's symptoms.  However, after the meningitis treatment, Tommy starts to become lucid and start asking for his favorite energy drink, "Super Juice". His father, Paul, tells him that he's going to take him back to England immediately, but Taub insists on holding him for observation.  Taub's precaution turns out to be wise when Tommy has a seizure.

Tommy goes code blue again and has to be defibrillated.

House orders a blood analysis to look for drugs, but after using $1,100 of the budget, 2 tongue depressors and 5 ward favors, the results rule out narcotic abuse.

Further blood analysis shows a low glomular filtration rate, a sign of low kidney function. After using 32 head meds and 6 oxygen masks, they rule out carcinoid syndrome.

A final blood analysis shows that Tommy is lactose intolerant. This explains his abdominal pain.  After using 34 body meds and 6 gauze, they can rule out gastroenteritis.

House treats Tommy for phenylketonuria with 5 ward favors, $1,200 of budget and 4 gauze.  Tommy is soon lucid again. House asks Tommy's mother Katie whether Tommy drank milk as a child.  She says that because their nanny was lactose intolerant, they didn't keep it in the house.  House realizes that as doctors never tested Tommy for lactose intolerance, they probably never tested him for phenylalanine intolerance either which often accompanies it.  Tommy could not process the phenylalanine in his energy drinks, which slowly built up in his body.  He has to stop drinking Super Juice and has to start using an inhaler.

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