Child With Complaints of Vomiting,Fits,Respiratory Distress

4th Pediatric Infectious Diseases Conference

ISSN 0973 - 0958

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Rakesh Kumar, Binay Ranjan, Manjul Vijay Department of Pediatrics, Katihar medical college, Katihar...

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	Specialist Answers
Question
A 3 month male child weighing 3.3 kg, was repeatedly admitted after every 7 days from the age of 2 months of life with complaints of vomiting, fits or respiratory distress. He is on exclusive mother's feed. He has been found to have persistent hyponateramia, hyperkalemia and metabolic acidosis AND was HYPOTENSIVE. His serum ACTH value was 17, OH-progesterone and plasma renin was sent after 12 hours of commencement of normal saline. results are following Serum --ACTH -----135 mg\dl (normal-46 mg/dl) , -plasma renin------0.29 mg/dl -17, OH- Progesterone ---12 mg/dl ( age adjusted < 2mg/dl) ---SERUN ANION GAP ------25 TREATMENT GIVEN: 1-I/V FLUID NORMAL SALINE FOR INITIAL two DAYS 2-TREATMENT FOR HYPERKALEMIA 3-HYROCORTISONE on stress dose(40mg/m2/day in three divided doses continued for 7days ,and was then shift to 20 mg/m2/day in divided doses) 4- FLORINEF 0.2 MG/DAY IN TWO DIVIDED DOSES. Serum CORTISOL, ALDOSTERONE TESTOSTERONE could not be sent initially due to financial constrained. Later when patient remain hyponateremic ( plasma Na ranges between 129----131mmol/l) on 0.2mg Florinef , diagnosis was re evaluated and following investigation was sent , note patient is continuously taking medication when investigation was sent ---TESTOSTERONE LEVEL---- LOW NORMAL -SERUM CORTISOL ------- LOW NORMAL -ALDOSTERONE ---REPORT AWAITED MY QUESTIONS ARE: 1- WHAT ARE THE DIFFERENTIAL DIAGNOSIS 2- WHAT IS THE FURTHER MANAGEMENT REQUIRED?
Answer
Rule out the following: PSEUDOHYPOALDOSTERONISM 17-Hydroxylase Deficiency Syndrome Adrenal Hypoplasia KETOACIDOSIS DIABETIC KETOACIDOSIS RENAL FAILURE Back to All Questions

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