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You are evaluating a 6-month-old child who has a ventricular septal defect and is scheduled for cardiac surgery. The childs weight is 6 kg (3rd percentile), length is at the 30th percentile, and head circumference is at the 50th percentile. His mother states she prepares the formula by adding 1 scoop of powder to 2 oz of water. She estimates that he drinks 24 oz of formula per day. You estimate the babys intake is approximately 500 kcal per day of cow milk formula, which is the recommended dietary allowance (RDA) for his age. According to his mother, he spits up three times a day and passes two soft stools daily. On physical examination, you hear a 3/6 holosystolic murmur and palpate the liver 1 cm below the right costal margin. Of the following, the BEST explanation for the childs malnutrition is:

caloric requirements exceeding RDA
cow milk protein intolerance
incorrect preparation of formula
pathologic gastroesophageal reflux
undiagnosed pancreatic insufficiency
Total Votes : 410

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