WBC: white blood cell; Hb: hemoglobin; Hct: hematocrit; Plt: platelet;
S.Cre: serum creatinine; Na: sodium; K: potassium; Cl: chloride; Ca:
calcium; Mg: magnesium; T-bil: total bilirubin; AST: aspartate
aminotransferase; ALT: alanine aminotransferase; Glu (RBS): glucose
(random blood sugar); CRP: c-reactive protein; 17-OHP:
17-hydroxyprogesterone.
X-ray erect abdomen was normal as shown in Fig 2. ECG was interpreted to
be normal. Ultrasonography of the abdomen and pelvis (Fig 3.1 & 3.2)
showed bilateral increased renal echotexture probably due to dehydration
and prominent left renal pelvicalyceal system with an anteroposterior
diameter of renal pelvis 11mm. The patient was given supportive measures
and started on antibiotics to cover possible sepsis but the work-up for
sepsis later came back negative. The electrolyte levels on day two
showed Na-119 mmol/l, K-6.0 mmol/L. The morning sample for Cortisol
drawn at 8 am on day two showed decreased levels of the hormone (60.7
nmol/L). Patient was started on Hydrocortisone 15 mg IV eight hourly
with hourly monitoring of vitals. The blood was drawn and sent for
17-hydroxyprogesterone (17-OHP) for suspicion of CAH which was found to
be elevated 2.4 nmol/L (normal: 0.06-0.27) indicative of the diagnosis.
His glucose and electrolytes were monitored daily while in the hospital,
which gradually improved by the seventh day of hospitalization. Further
clinical testing was refused by the parents of the child. After the
improvement in clinical signs, the patient was discharged home on
replacement therapy consisting of oral prednisolone and fludrocortisone
acetate. He was followed up after seven days in the outpatient
department. His weight had improved, electrolytes were normal and
medications were adjusted according to his weight.