Which of the following is the most likely definitive treatment for a 3-week-old infant presenting with vomiting, lethargy, hypoactivity, mottled skin, hypotension, tachycardia, hyp... Which of the following is the most likely definitive treatment for a 3-week-old infant presenting with vomiting, lethargy, hypoactivity, mottled skin, hypotension, tachycardia, hyponatremia, hyperkalemia, hypoglycemia and hypercalcemia?
Understand the Problem
The question describes a 3-week-old infant presenting with vomiting, lethargy, hypoactivity, mottled skin, and abnormal lab results (low sodium and glucose, high potassium, high ionized calcium). Vital signs indicate hypotension and tachycardia. The question asks for the most likely definitive treatment. We should consider what condition is best supported by the constellation of symptoms and lab findings. It is important to consider the patient's age in interpreting the normal values of test results.
Answer
Hormone replacement therapy with corticosteroids and mineralocorticoids.
The constellation of symptoms (vomiting, lethargy, hypoactivity, mottled skin, hypotension, tachycardia, hyponatremia, hyperkalemia, hypoglycemia and hypercalcemia) in a 3-week-old infant is highly suggestive of congenital adrenal hyperplasia (CAH), specifically the salt-wasting form. The definitive treatment would involve hormone replacement therapy, primarily with corticosteroids (like hydrocortisone) and mineralocorticoids (like fludrocortisone) to correct the hormonal deficiencies..
Answer for screen readers
The constellation of symptoms (vomiting, lethargy, hypoactivity, mottled skin, hypotension, tachycardia, hyponatremia, hyperkalemia, hypoglycemia and hypercalcemia) in a 3-week-old infant is highly suggestive of congenital adrenal hyperplasia (CAH), specifically the salt-wasting form. The definitive treatment would involve hormone replacement therapy, primarily with corticosteroids (like hydrocortisone) and mineralocorticoids (like fludrocortisone) to correct the hormonal deficiencies..
More Information
The symptoms described in the question are consistent with a salt-wasting crisis, a life-threatening condition that can occur in infants with congenital adrenal hyperplasia (CAH). Prompt diagnosis and treatment are essential to prevent serious complications and ensure the infant's survival.
Tips
It's easy to confuse the various endocrine disorders that can present in infancy. Remembering the key electrolyte imbalances (hyponatremia, hyperkalemia) is crucial for suspecting CAH.
Sources
- Question Sets and Answers - PMC - PubMed Central - pmc.ncbi.nlm.nih.gov
- [PDF] Questions - UHS WEBSITE - uhs.edu.kh
- Electrolyte disturbance in an infant with failure to thrive - PMC - pmc.ncbi.nlm.nih.gov
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