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Problem solving in clinical practice
Problem solving in clinical practice: the sick infant with low sodium and high potassium
  1. Yincent Tse1,2,
  2. Nidhi Singhal1,
  3. Leigh McDonald3,
  4. Milan Gopal4,
  5. Anupam Lall4,
  6. Helen Johnstone5,
  7. Timothy Cheetham6
  1. 1 Department of Paediatric Nephrology, Great North Children"s Hospital, Newcastle upon Tyne, UK
  2. 2 Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
  3. 3 Department of Radiology, Great North Children"s Hospital, Newcastle upon Tyne, UK
  4. 4 Department of Paediatric Urology, Great North Children"s Hospital, Newcastle upon Tyne, UK
  5. 5 Department of Paediatric Endocrinology, Great North Childrens Hospital, Newcastle upon Tyne, UK
  6. 6 Translational and Clinical Research Institute, Newcastle University c/o Department of Paediatric Endocrinology, Great North Children’s Hospital, Newcastle upon Tyne, UK
  1. Correspondence to Dr Yincent Tse, Department of Paediatric Nephrology, Great North Children"s Hospital, Newcastle Upon Tyne NE1 4LP, UK; yincenttse{at}nhs.net

Abstract

Many paediatricians will be faced with a sick infant who on investigation is found to have hyponatraemia and hyperkalaemia at some time in their career. The focus of initial management includes the treatment of potentially life-threatening hyperkalaemia with concurrent investigation aiming to elucidate whether the underlying cause reflects a primarily renal or endocrine pathology. We describe the presentation of two infants who each presented with one of the more common underlying diagnoses that led to this biochemical disturbance and discuss the approach to immediate treatment, diagnostic work-up and longer term management.

  • hyperkalaemia
  • hyponatraemia
  • congenital adrenal hyperplasia
  • aldosterone
  • neonatology

https://doi.org/10.1136/archdischild-2019-317756

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    Footnotes

    • Twitter @YincentTse

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Parental/guardian consent obtained.

    • Provenance and peer review Commissioned; externally peer reviewed.

    • Data availability statement Data are available upon request;