PT - JOURNAL ARTICLE AU - Buthaina Buzakuk AU - Judith van der Voort TI - Metabolic mayhem. The advantage of keeping your nose both in the books and in the nappy! AID - 10.1136/archdischild-2019-318477 DP - 2022 Apr 01 TA - Archives of disease in childhood - Education & practice edition PG - 150--155 VI - 107 IP - 2 4099 - http://ep.bmj.com/content/107/2/150.short 4100 - http://ep.bmj.com/content/107/2/150.full SO - Arch Dis Child Educ Pract Ed2022 Apr 01; 107 AB - This case presentation takes you on a journey of diagnostic hurdles, covering a common neonatal presentation: abdominal distention with failure to pass meconium, followed by a presentation in infancy with metabolic, renal and electrolyte abnormalities. The article provides a systematic approach to the different clinical problems, allowing interpretation of results, making differential diagnoses and deciding on investigations and management.