A salt wasting syndrome in infancy

Abstract

The case is presented of an infant who failed to thrive and to maintain hydration satisfactorily. He was found to have a renal salt wasting defect. Adrenal and kidney function and acid-base balance were found to be normal. Low sweat electrolyte levels were taken as evidence of adequate production of mineralo-corticoid. This deleterious clinical situation could be reversed by raising the serum concentration to normal with the addition of 5 g. of sodium chloride to the milk intake. When the patient was off salt or on DOCA only, the serum sodium concentration, the extracellular volume and the total chloride fell or were low and the clinical condition deteriorated. DOCA had no effect on the urinary sodium/potassium ratio. If electrolyte concentration of sweat is a satisfactory index of endogenous mineralo-corticoid production, then this child's salt wasting condition may be related to a transient disturbance in the response of the renal tubules to this hormone.