Which of the following is the most likely definitive treatment for a 3-week-old infant presenting to the Emergency Room with history of vomiting, lethargy, hypoactivity, mottled sk... Which of the following is the most likely definitive treatment for a 3-week-old infant presenting to the Emergency Room with history of vomiting, lethargy, hypoactivity, mottled skin, blood pressure 50/30 mmHg, heart rate 180/min respiratory rate 56/min temperature 36.6 °C, oxygen saturation 95%, 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?
Understand the Problem
The question describes a 3-week-old infant presenting with vomiting, lethargy, hypoactivity, mottled skin, and abnormal lab results. The infant shows signs of shock (hypotension, tachycardia) and the lab results indicate electrolyte imbalances (low sodium, high potassium), hypoglycemia, and possible renal dysfunction. The question asks to identify the MOST LIKELY definitive treatment based on the presentation and lab findings.
Answer
Hydrocortisone and fludrocortisone administration, along with IV fluids.
The infant's symptoms and lab values are consistent with congenital adrenal hyperplasia (CAH), specifically the salt-wasting form. The most likely definitive treatment is administration of hydrocortisone and fludrocortisone to correct the hormone deficiencies, along with intravenous fluids (possibly containing dextrose) to address the acute crisis.
Answer for screen readers
The infant's symptoms and lab values are consistent with congenital adrenal hyperplasia (CAH), specifically the salt-wasting form. The most likely definitive treatment is administration of hydrocortisone and fludrocortisone to correct the hormone deficiencies, along with intravenous fluids (possibly containing dextrose) to address the acute crisis.
More Information
The presentation is concerning for a salt-wasting crisis due to congenital adrenal hyperplasia (CAH). The key findings include: vomiting, lethargy, hypoactivity, hypotension (50/30 mmHg), tachycardia (180/min), tachypnea (56/min), temperature 36.6 °C, oxygen saturation 95%, hyponatremia (Sodium 122), hyperkalemia (Potassium 6.2), low glucose (1.2).
Tips
It is a common mistake to not recognise the constellation of symptoms and lab abnormalities as a salt-wasting crisis. Prompt recognition and treatment are critical.
AI-generated content may contain errors. Please verify critical information
