RT Journal Article SR Electronic T1 Metabolic mayhem. The advantage of keeping your nose both in the books and in the nappy! JF Archives of disease in childhood - Education & practice edition JO Arch Dis Child Educ Pract Ed FD BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health SP 150 OP 155 DO 10.1136/archdischild-2019-318477 VO 107 IS 2 A1 Buthaina Buzakuk A1 Judith van der Voort YR 2022 UL http://ep.bmj.com/content/107/2/150.abstract 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.