Extreme hypernatraemia, breast-feeding and red skin

Excerpt

A term female 3.76-kg infant was noted at birth to have red, peeling skin with normal scalp hair (Fig. 1). A diagnosis of ichthyosis was made. Breast-feeding was initially difficult, and after discharge at 6 days of age she was admitted at 9 days because of poor feeding, floppiness, lethargy and dry nappies for 24 h. The baby’s weight was 2.64 kg (a 30% decrease from the birth weight), and initial blood results showed a sodium level of 227 mmol/l, potassium 8.8 mmol/l, bicarbonate 12 mmol/l, base excess −12.5, urea 91.4 mmol/l and creatinine 570 μmol/l. After initial resuscitation with 60 ml/kg intravenous fluids, she was transferred to our unit where she was commenced on peritoneal dialysis (PD). The sodium concentration of the PD fluid was increased initially from 132 to 180 mmol/l and gradually reduced with a corresponding fall in serum sodium levels (Fig. 2). Anuria persisted for 4 days, and a total of 6 days PD was required. Renal function gradually returned to normal.

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