Cao Xin-Cheng, Chen Yuan-Yuan, Zhang Ke, Zhang Xun-Jie, Yang Lin, Li Zhi-Hua
Department of Neonatology, Children's Hospital of Fudan University/National Children's Medical Center, Shanghai 201102, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2023 Jul 15;25(7):774-778. doi: 10.7499/j.issn.1008-8830.2305011.
An 18-day-old male infant was admitted to the hospital due to recurrent hyperkalemia for more than 10 days. The neonate had milk refusal and dyspnea. The blood gas analysis revealed recurrent hyperkalemia, hyponatremia and metabolic acidosis. Adrenocortical hormone replacement therapy was ineffective. Additional tests showed a significant increase in aldosterone levels. Family whole exome sequencing revealed that the infant had compound heterozygous in the gene, inherited from both parents. The infant was diagnosed with neonatal systemic pseudohypoaldosteronism type I. The infant's electrolyte levels were stabilized through treatment with sodium polystyrene sulfonate and sodium supplement. The infant was discharged upon clinical recovery. This study provides a focused description of differential diagnosis of salt-losing syndrome in infants and introduces the multidisciplinary management of neonatal systemic pseudohypoaldosteronism type I.
一名18日龄男婴因反复高钾血症10余天入院。该新生儿有拒奶和呼吸困难症状。血气分析显示反复高钾血症、低钠血症和代谢性酸中毒。肾上腺皮质激素替代治疗无效。进一步检查显示醛固酮水平显著升高。家族全外显子测序显示该婴儿在该基因上存在复合杂合突变,分别遗传自父母双方。该婴儿被诊断为I型新生儿全身性假性醛固酮减少症。通过聚苯乙烯磺酸钠和补充钠治疗,婴儿的电解质水平得以稳定。临床康复后婴儿出院。本研究重点描述了婴儿失盐综合征的鉴别诊断,并介绍了I型新生儿全身性假性醛固酮减少症的多学科管理。