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Old 07-11-2011
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Question A 6 month old baby boy has poor weight gain

A 6 month old baby boy has poor weight gain. His current weight is less than 5th percentile, height 10th percentile and head circumference at 50th percentile. The planned pregnancy resulted in a normal, spontaneous vaginal delivery; mother and child were discharged after 48 hours of hospitalization. Feeding is via breast and bottle; the quantity seem sufficeint. The child has had no other illness. The examination is unremarkable except for the child's small size. Screening lab shows hemoglobin 11 mg/dl and hematocrit 33%. Serum electrolyte levels are sodium 140, chloride 105, potassium 2.9, bocarbonate 17 bun 15 and creatinine 0.3. Liver function test are normal. Urianalysis reveal a pH of 8 with no white blood cells, bacteria,protein,ketones or reducing substances. Which of the following is the most appropriate therapy for this child?

A. Transfusion with packed red blood cells?
B. Intravenous infusion of potassium chloride
C. Sweat chloride analysis
D. Growth hormone analysis
E. Oral supplementation with bicarbonate
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Old 07-11-2011
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B. Intravenous infusion of potassium chloride
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Old 07-12-2011
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confused between B&C
ithink it is cf
C. Sweat chloride analysis
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Old 07-12-2011
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The answer is E. The patient has evidence of renal tubular acidosis (probably tubular) a well described cause of failure to thrive. Upon confirmation , oral bicarbonate supplementation would be expected to correct the elevated chloride level, the low bicarbonate and potassium levels (although potassium supplements may be required) and poor growth.
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docnas (07-12-2011), USMLE-Syndrome (07-12-2011)



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