We report the case of a three-month-old infant with a one-month history of refusal to take, nausea, regurgitation and vomiting.
For this reason she was referred from Primary Care to the Emergency Department.
He was a term birth weight appropriate for gestational age, with a normal course pregnancy in which polyhydramnios was not observed.
The neonatal period was uneventful, presenting adequate psychomotor and height development up to two months of age, when the clinical presentation was described.
Upon arrival at the Emergency Room, the patient was impressed by general condition, dry, ojerous mucous membranes, capillary refill greater than 2 seconds and cutaneous dryness, with rest of the normal physical examination.
Vital signs were: temperature, 36.6 °C; heart rate, 137 bpm; blood pressure, 88/55 mmHg (p75); O2 saturation, 100%; respiratory rate, 52 rpm; height, 90 cm.
It was expanded with saline and blood tests were performed, with normal and biochemical blood count, highlighting: Na 151 mEq/l; K 2.2 mEq/L; Cl 130 gap/l and Hall in normal calcium and albumin 13 mg/dl.
A urine dipstick with pH 7, density 1015 and negative rest was performed.
The patient required intravenous serum therapy with maximum potassium mEq/l and bicarbonate (3kg/day), and was discharged within one week, maintaining oral treatment with sodium bicarbonate and potassium citrate.
Renal ultrasound showed bilateral papillary hyperechogenicity, compatible with the onset of nephrocalcinosis.
Assessment was performed, bone series and auditory potentials were normal.
During the follow-up period up to nine months of age, the patient is asymptomatic, with maturational development (p25 of weight and p50 of height), so weight changes have been made according to dosage adjustments.
The laboratory tests performed six months after discharge are shown in Table 2.
Follow-up ultrasound performed six months after discharge showed persistent findings consistent with nephrocalcinosis.
