A 3-week-old infant presents to the Emergency Room with vomiting and lethargy. He is hypoactive with mottled skin and no focus of infection. Perinatal history was unremarkable. Blo... A 3-week-old infant presents to the Emergency Room with vomiting and lethargy. He is hypoactive with mottled skin and no focus of infection. Perinatal history was unremarkable. Blood pressure 50/30 mmHg, Heart rate 180/min, Respiratory rate 56/min, Temperature 36.6 °C, Oxygen saturation 95%. Lab results: Sodium 122, Potassium 6.2, Chloride 100, Bicarbonate 21, Calcium total 2.4, Calcium ionised 1.5, Blood urea nitrogen 3, Creatinine 44, Glucose 1.2. Which of the following is the most likely definitive treatment? A. Antibiotics B. Fluid and dextrose C. Dextrose and intralipid D. Cortisone and hormonal therapy
Understand the Problem
The question presents a case of a 3-week-old infant with vomiting, lethargy, hypoactivity, mottled skin, and abnormal lab results (low sodium, high potassium, low glucose). We need to determine the most likely definitive treatment based on the provided information.
Answer
Cortisone and hormonal therapy.
The most likely definitive treatment is D. Cortisone and hormonal therapy.
Answer for screen readers
The most likely definitive treatment is D. Cortisone and hormonal therapy.
More Information
The infant's symptoms (vomiting, lethargy, hypoactivity, mottled skin, hypotension, tachycardia) and lab results (hyponatremia, hyperkalemia, hypoglycemia) are suggestive of adrenal insufficiency, most likely congenital adrenal hyperplasia (CAH). CAH is a genetic disorder that affects the adrenal glands' ability to produce certain hormones, including cortisol and aldosterone. Treatment typically involves hormone replacement therapy with corticosteroids (e.g., cortisone) and mineralocorticoids to correct the hormonal deficiencies.
Tips
A common mistake is to focus solely on the low glucose and administer dextrose, which only temporarily addresses one aspect of the underlying problem. Antibiotics are not indicated as there is no identified infection. While fluids are important for resuscitation, they do not address the hormonal deficiency.
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