Chronic cough in an adolescent with infantile onset of hypokalemic hypochloremic metabolic alkalosis: Questions

Excerpt

A 6-month-old boy presented in August 2006, during the summer season in our country, with poor feeding, dehydration, and failure to thrive which started right after birth. He was born without polyhydramnios from healthy second-degree consanguineous parents at the 38th week of gestation. He had birth weight of 3350 g and body length of 50 cm, both of which were appropriate for his age. There was no prior history of diarrhea or other systemic infections, but he was hospitalized several times because of dehydration. He was fed with breast milk and formula suitable for his age but with poor feeding. At presentation, body weight was 7500 g (25–50th percentile), height: 72 cm (50–75th percentile), and blood pressure was normal. Skin turgor was decreased. Other physical examination findings were unremarkable. Laboratory results showed metabolic alkalosis, hyponatremia, hypokalemia, and hypochloremia. Hyperreninemic hyperaldosteronism was present. Urine examination revealed normal specific gravity and pH, without proteinuria, hematuria, pyuria, or glycosuria. Urine culture was negative. Urine output was in the upper range. Spot urine calcium/creatinine was within the normal range for age. Urine chloride was close to the lower limit but within the normal range. The laboratory results at 6 months of age are shown in Table 1. On abdominal ultrasonography, both kidneys were normal in localization and size with normal parenchymal thicknesses and echogenicity and no dilatation in the collecting systems. With a pre-diagnosis of antenatal Bartter syndrome, indomethacin was started with 1 mg/kg/day dosage. Hyponatremia, hypochloremia, and hypokalemia were corrected with intravenous fluids. The patient was discharged on indomethacin and potassium chloride supplementation. …