A 3-week-old infant presents to the ER with vomiting and lethargy. He is hypoactive with mottled skin and no focus of infection. Perinatal history was unremarkable. Blood pressure... A 3-week-old infant presents to the ER 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 show 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 clinical case of a 3-week-old infant with vomiting, lethargy, and abnormal lab results (hyponatremia, hyperkalemia, hypoglycemia). It asks for the most likely definitive treatment. We need to analyze the symptoms and lab values to determine the underlying condition and the most appropriate treatment option. Based on the limited information provided, the most likely diagnosis is congenital adrenal hyperplasia (CAH), specifically the salt-wasting form, which is characterized by hyponatremia, hyperkalemia, hypoglycemia, and dehydration/shock. However, without further diagnostic tests, the optimal treament that could reverse the symptoms is fluids and dextrose.
Answer
The most likely definitive treatment is Cortisone and hormonal therapy.
The most likely definitive treatment is Cortisone and hormonal therapy, this is because the infant is presenting with signs and symptoms of congenital adrenal hyperplasia (CAH), which include vomiting, lethargy, hypoactivity, mottled skin, hypotension, tachycardia, and hyponatremia, hyperkalemia, and hypoglycemia. The definitive treatment for CAH is cortisone and hormonal therapy to replace the deficient hormones.
Answer for screen readers
The most likely definitive treatment is Cortisone and hormonal therapy, this is because the infant is presenting with signs and symptoms of congenital adrenal hyperplasia (CAH), which include vomiting, lethargy, hypoactivity, mottled skin, hypotension, tachycardia, and hyponatremia, hyperkalemia, and hypoglycemia. The definitive treatment for CAH is cortisone and hormonal therapy to replace the deficient hormones.
More Information
The patient's symptoms and lab results (hyponatremia, hyperkalemia, hypoglycemia) strongly suggest congenital adrenal hyperplasia (CAH). CAH is caused by a deficiency in enzymes needed to produce cortisol and aldosterone. Treatment involves hormone replacement with corticosteroids (like cortisone) and mineralocorticoids to correct the hormonal imbalances.
Tips
A common mistake is to only focus on one aspect of patient presentation. Always consider the whole clinical picture.
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