Chotai Amar Ajay, Mitra Dipayan
Department of Neuroradiology, Royal Victoria Infirmary, Newcastle-upon-Tyne, United Kingdom.
BJR Case Rep. 2021 May 14;7(5):20210057. doi: 10.1259/bjrcr.20210057. eCollection 2021 Sep 8.
We present a 1-year-old boy who presented to the emergency department with a 7-day history of diarrhoea and vomiting. The initial renal function profile demonstrated a urea of 55 mmol l (normal range between 5 and 20 mmol l), creatinine 695 micromol/L (normal range between 62-106 micromol/L) and potassium 9.1 mmol l (normal range between 3.5-5.0 mmol l), with a profound metabolic acidosis. Upon examination, there were no significant findings, specifically no neurological abnormality. He was prescribed back-to-back Salbutamol nebulisers, to increase the shift of extracellular potassium into the intracellular space, followed by i.v. calcium gluconate, with some improvement in potassium levels. A further 5 mmol of sodium bicarbonate was given, as well as a stat dose of 1 mg/kg furosemide, and per rectal calcium resonium. He was then commenced on an infusion with 10% dextrose with insulin. He was subsequently found to be in urinary retention and a catheter was inserted, which drained 1700 ml. A subsequent renal function profile, 24 hours after admission, demonstrated improvement with urea 39 mmol l, creatinine 300 micromol/L and potassium 3.0 mEq/L.
我们报告一名1岁男童，因腹泻和呕吐7天就诊于急诊科。初始肾功能检查显示尿素为55 mmol/L（正常范围5至20 mmol/L），肌酐695微摩尔/升（正常范围62 - 106微摩尔/升），钾9.1 mmol/L（正常范围3.5 - 5.0 mmol/L），伴有严重代谢性酸中毒。体格检查未发现明显异常，特别是无神经学异常。给他开具了连续的沙丁胺醇雾化吸入剂，以促进细胞外钾向细胞内转移，随后静脉注射葡萄糖酸钙，钾水平有所改善。又给予了5 mmol碳酸氢钠，以及一剂1 mg/kg速尿静脉推注，并经直肠给予降钾树脂。然后开始用含胰岛素的10%葡萄糖进行静脉输注。随后发现他存在尿潴留，插入导尿管后引出1700毫升尿液。入院24小时后的后续肾功能检查显示有所改善，尿素为39 mmol/L，肌酐300微摩尔/升，钾3.0 mEq/L。
