Three Days Later…
Glass doors parted in the adjacent study and House ambled in holding four identical files. He passed his team altogether as he headed straight for the coffee pot in the far corner of the room, but not before dumping all four blue files on the table.
Foreman picked up his copy off the table. "New case?"
With his red mug in hand, House answered back as he poured himself a cup of coffee. "Nope, we got a rerun."
Chase was lightly thumbing though his copy until he heard that and scoffed. "He's back in? Wasn't he in juvenile detention?"
House set his mug at the head of the table and manned the position at the dry erase board with a marker in hand. "Had another seizure."
"Let me guess," Foreman cut in, "it was in front of correctional officers this time."
"That's why we call it a rerun."
"Was there another crazy story to go with that seizure?" asked Foreman. House's lack of answer was telling. "And you're taking him again?" he exasperated.
Cameron, who had already skimmed the file looked up, "It's not like he was released AMA, why are we readmitting him?"
"You're right, it's not like he was released against Cuddy's medical advice, but we never explained his chemical imbalance."
"So Cuddy doesn't know he's back in here?" Cameron asked.
House shrugged. "Cuddy knows what she needs to know." He gestured back to the board. "Can we get started here?"
"It's just low calcium," said Chase in complete disbelief as he pulled back from the file and leaned back in his seat, "This is just a kid that makes up huge lies and doesn't drink his milk."
House abandoned his coffee mug to the table and in his usual scrawl wrote 'Hypocalcemia' across the top of the board. "Who's also had two seizures. His calcium levels are starting to hit the floor. So what if he lies a little more than usual; now he has the heart arrhythmia he should have had three days ago. You think the electrocardiogram's gonna lie when he dies?" House poised a marker over the whiteboard: "Differential diagnosis for low calcium levels."
"Hypoparathyroidism?" asked Chase with little interest in the reply.
House shook his head as he wrote down an abbreviated version of the word, "There's no other evidence of low Parathyroid Hormone," he scrawled a small 'x' beside it, "So that takes out Pseudohypoparathyrodism too. What else?"
Foreman and Cameron picked their heads up and answered as one, "Vitamin D deficiency."
With 'VIT. D' on the board, House turned around muttering as much to himself as to the others, "That would indicate a renal disease, he's had no fever, no abdominal swelling." He put a question mark by that. "Come on, people; give me something else."
"Magnesium deficiency?" asked Cameron.
House quickly wrote down 'Mg' and circled it. "That explains the twitching, and low magnesium is consistent with asthma. Anything else?"
Foreman objected. "He didn't twitch."
"Yeah, the wonderful thing about cops is they can't tell the difference between seizures and break dancing. The cop's account may be no more accurate than the kid's."
"Bone marrow transplant?" asked Chase with a tone that betrayed his dislike of the whole meeting.
"Nothing like that was in his records," Cameron countered.
House pounced on this lack of enthusiasm too with his own ire. "Come on now, Chase. We're talking about a life here, not some theoretical Q and A."
"What about ethylene glycol poisoning?" asked Foreman.
Chase countered this one. "You think the kid's been drinking antifreeze?"
Foreman leaned forward to get a better look at Chase. "Look at his arms and back. They are covered with tattoos. One of them is fresh."
After a beat to think about it, Chase stumbled with, "I don't see what you're getting at."
Foreman was about to elaborate when the realization came to House. "A minor that wants a tattoo can't get it anywhere that has any legitimacy. And those garage tattoo artists use just about anything including Listerine and Gatorade to formaldehyde and ethylene glycol to keep those inks in suspension. Run a serum concentration test. While you're waiting for the results, ready him for hemodialysis to clear the crap out of his system." His team was already starting to leave as House made his final call, "If his calcium falls any lower, ready IV calcium gluconate and watch his breathing!"
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House was absorbed watching General Hospital when Chase walked in with lab results. "He tested positive for ethylene glycol poisoning."
Something in the tone of Chase's voice made House lower the volume on his TV and turned his chair to fully face Chase in annoyance. "But there's something you're not telling me. With his calcium levels and the seizures he should have at least a fifty." Without waiting for explanation, he tore the paper from Chase's hand looked at the lab result.
11 mg/dL
House scratched his head as he stared at the computer printout. 11 mg/dL. It was a positive exposure of ethylene glycol indeed, but nowhere near the 50 mg/dL or more he was expecting, and certainly not enough to explain his severity of symptoms or for treatment they had ready. "Have you started him on hemodialysis?"
"No," answered Chase as he stepped back. "We wanted to know what you-"
"Cancel it," House interrupted as he stood, "This will wash out of his system in two days. Did you check his magnesium?"
"It's normal," said Chase as he allowed House to pass and followed him out of his office, "What do you want to say to his grand-"
"Say anything you can to keep him here. Lie to her. She's the one who got Cuddy to pull him out of here in the first place." Then he added as it occurred to him, "And get everybody back in here!"
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"Let's make this fast. I need to be out of here by four." House said from his front row seat of the whiteboard. The words 'Ethylene Glycol' joined the other cast out causes of low calcium with a line crossing through it. He propped his running shoes on the glass table.
"Again? Where are you going?" Cameron asked.
House didn't even turn his head to her. "The hooker Cuddy recommended is in high demand. That was the only time she had available." He finally looked back at them. "Let's start."
"There's no reason to keep him here anymore. This fits. Chronic exposure to ethylene glycol can bind with calcium and crystallize in his kidneys. He needs to stop before his kidney's shut down."
That idea had come from Chase as House studied the whiteboard. Some of it had merit, but, "This particular exposure was recent. If this involved the kidney's we'd seen more than just low calcium. Everything else has been normal that we've seen so far. This exposure was probably done with the help of someone else in juvie. He may be lying, but those tests don't."
"Then we're back to square one," said Cameron, "Slightly slow calcium levels and two seizures that don't fit." The silence following that was almost deafening.
"We're not back at square one. He's worse now than when he first got in here." After several moments, House recapped his marker and muttered as much to himself as to the others in the room, "We've never considered sepsis as a cause because of the fact he's had no fever."
"Right," answered Chase, "Fever is one of the most basic of immune responses. The body brings its temperature up to try to get out of the tolerance range of whatever's infecting it. It's the first line of defense."
Foreman nodded. "So no fever, no infection; no infection, no sepsis."
"And low calcium is supposed to show in the beginning with tingling extremities and an abnormal ECG, then seizure." He looked back at Chase and Foreman. "Did Pinocchio do this in the right order?"
Foreman scoffed. "We still don't have definitive evidence that the two are related. It is more likely that he was exposed to something from his environment."
House blinked at that one. "Sure, juvie and home-maybe a few extra curtains in one and a few extra bars in the other; basically the same thing. The homemade spaghetti still tastes the same."
The sarcasm was not lost on Foreman as he shrugged. "He moved in with his grandmother's about a month or so ago. That's when his behavior problems started. Whatever he was exposed to may have started then and now has reached the tipping point."
"Then go find it." At Foreman's surprised look House forced, "You heard me. Don't come back 'till you find something… Go!"
Foreman nodded, stood, and left with his jacket under his arm.
"I want you two," House said as soon as Forman was out of earshot, "to start the kid of broad spectrum antibiotics and run any blood tests you can think of that may tell us something useful."
"You're still thinking infection?" Cameron asked. When House nodded she continued, "then why did you let Foreman-?"
"He's useless right now. He was two minutes from going anyway. Run your tests. I want a picture of what this kids' blood is sending his brain."