Clinopathalogical Conference

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Clinopathalogical Conference

• 2004-05

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Chief Complaints

• A 6 ½-year-old girl was admitted to hospital
  because of failure to thrive.

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Physical Examinations

• General appearanceA stunted, apathetic girl with
  protuberant abdomen and slender extremities.
• BW17 Kg (10th percentile) BH96.2 cm (lt3rd
  percentile).
• Mild generalized muscle hypotonia and enlarged
  abdomen.

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Laboratory studies

• Serum uric acid0.55 mmol/l (0.13-0.39)
• Serum aspartate aminotransferase0.71 µmol.s-1/l
  ()
• Alkaline phosphatase602 IU/l (145-420)
• Triglycerides0.6 g/dl (0.35-1.14)
• Blood sugar1.7 mmol/l (3.3-5.5)
• Blood lactate8.9 mmol/l (0.8-1.5)

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Laboratory Studies

• ABGpH7.32, HCO3-9 mmol/l
• Repeated Urianalysesno proteinuria or
  abnormality in sediment.
• Urine cultureNo growth.

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Other studies

• Intravenous pyelogramBilateral enlarged kidneys
  but no other abnormalities.
• Bone radiographsNo rickets or hyperparathyroidism
  .

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Hospital Course

• She was treated with sodium bicarbonate for
  metabolic acidosis.
• Despite increasing the doses or oral sodium
  bicarbonate to 8 mmol/Kg/day, metabolic acidosis
  persisted.

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Problems List

• Major Problems
• Failure to thrive
• Metabolic acidosis

• Minor Problems