Percorsi clinici
Un lattante distrofico con alcalosi metabolica
A DISTROPHIC INFANT WITH METABOLIC ALKALOSIS
LORENZO CALLIGARIS1, GABRIELE CONT1, DANIELA CODRICH2, FLORIANA ZENNARO3, FEDERICO MARCHETTI1
1Clinica Pediatrica, IRCCS “Burlo Garofolo”, Trieste
2Dipartimento di Chirurgia Pediatrica, IRCCS “Burlo Garofolo”, Trieste
3UO di Radiologia, IRCCS “Burlo Garofolo”, Trieste
Febbraio 2006 - pagg. 111 -114
Abstract
We describe a case of a 4 months-old girl who come to our attention because of an history of failure to thrive and recurrent vomiting started during the second month of life; only remarkable laboratory data were the presence of hyponatriemia and hypochloremia. Physical examination showed a miserable looking child, with a weight under the 3rd percentile; blood gas analysis revealed a metabolic alkalosis. We report this case not because of its difficult diagnosis, but as an example of clinical course in the interpretation of failure to thrive during the first months of life; in this report we analyze the importance of some laboratory examinations (blood gas analysis) and the main aspects of some diagnostic hypothesis (hypertrophic pyloric stenosis, metabolic inborn errors, 21-hydroxilase deficiency).
Parole chiave
Suggerite dall'AI
Classificazione MeSH
Bibliografia
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2. Hernanz-Schulman M. Infantile Hypertrophic Pyloric Stenosis. Radiology 2003;227 (2):319-31.
3. Yagmuriu A, Barnhart DC, Vernon A, Georgeson KE, Harmon CM. Comparison of the incidence of complications in open and laparoscopic pylorotomy: a concurrent single institution series. J Pediatr Surg 2004;39(3):292-6.
4. van der Bilt JD, Kramer WL, van der Zee DC, Bax NM. Laparoscopic pylorotomy for hypertrophic pyloric stenosis: impact of experience on the results in 182 cases. Surg Endosc 2004;18(6):907-9.
5. Hall NJ, Van der Zee J, Tan HL, Pierro A. Meta-analysis of laparoscopic versus open pylorotomy. Ann Surg 2004;240(5):774-8.
6. Kim SS, Lau ST, Lee SL, et al. Pyloromyotomy: a comparison of laparoscopic, circumumbilical, and right upper quadrant operative techniques. J Am Coll Surg 2005;201(1):66-70.
7. Garza JJ, Morash D, Dzakovic A, Mondschein JK, Jaksic T. Ad libitum feeding decreases hospital stay for neonates after pylorotomy. J Pediatr Surg 2002;37(3):493-5.
8. van der Bilt JD, Kramer WL, van der Zee DC, Bax NM. Early feeding after laparoscopic pyloromyotomy: the pros and the cons. Surg Endosc 2004;18(5):746-8.
9. Kretz B, Wafta J, Sapin E. Our experience in “ad libitum” feeding after pyloromyotomy (review of 97 cases). Arch Pediatr 2005;12(2): 128-33.
10. Kawahara H, Imura K, Nishikawa M, Yagi M, Kubota A. Intravenous atropine treatment in infantile hypertophic pyloric stenosis. Arch Dis Child 2002;87;71-4.
11. Williams AJ. Assessing and interpreting arterial blood gases and acid-base balance. BMJ 1998;317;1213-6.
12. Burton BK. Inborn errors of metabolism in infancy: a guide to diagnosis. Pediatrics 1998;102(6):E69.
13. Nelson Textbook of Pediatrics. 17th edition. WB Saunders Company, 2004:1229-31.
Corrispondenza: orenzo.calligaris@inwind.it