SEVERE HYPONATREMIA AND METABOLIC ACIDOSIS IN A TODDLERWITH STEROID–RESISTANT NEPHROTIC SYNDROME FOLLOWING ACUTE GASTROENTERITIS
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Keywords
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Abstract
Background
Steroid-resistant nephrotic syndrome (SRNS) accounts for3–15%ofchildhood nephrotic syndromeand is associated with significant morbidity, progression to chronic kidney disease, and susceptibilityto complications. Intercurrent infections, such as gastroenteritis, may precipitate severe fluid andelectrolyte derangements, including hyponatremia and metabolic acidosis, which can be life-threatening in pediatric SRNS.
Case Presentation
We report a 3-year-old male with SRNS and underlying minimal change nephropathy who presentedwith acute gastroenteritis, complicated by severe hyponatremia (Na⁺ 120mEq/L) and metabolicacidosis (HCO₃⁻ 13.9mEq/L). The child developed vomiting and watery diarrhoea without fever oroliguria. Laboratory investigations confirmed critical electrolyte disturbances despite preserved renalfunction. Management involved prompt intravenous fluids, cautious electrolyte correction,intravenous hydrocortisone, and broad-spectrum antibiotics, followed by supportive therapy. Thechild’s condition stabilized by Day 5, allowing transition to oral therapy, including alternate-dayprednisolone, enalapril, atorvastatin, calcium carbonate with vitamin D, zinc, folic acid, nitazoxanide,loperamide, co-trimoxazole prophylaxis, and probiotics.
Discussion
This case underscores the complexity of SRNS with minimal change nephropathy during intercurrentinfections. Severe hyponatremia and metabolic acidosis compounded by diarrheal losses andhypoalbuminemia highlight the need for vigilant monitoring. Notably, corticosteroids were continuedwithout additional immunosuppressive agents, reflecting individualized clinical decision-making inreal-world practice, which may diverge from guideline recommendations advocating calcineurininhibitors in SRNS.
Conclusion
Children with SRNS are particularly vulnerable to electrolyte crises during infections. Earlyrecognition and correction of hyponatremia and metabolic acidosis are crucial to prevent fatalcomplications. This case emphasizes the importance of tailored therapeutic strategies and highlightsthe gap between guidelines and real-world management in pediatric SRNS.
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Annalakshmi S
Pharm.DVIYear, Department of PharmacyPractice, School of PharmaceuticalSciences,VelsInstitute of Science, Technology and Advanced Studies, Pallavaram, Chennai-600117.
Jothish Ram M
Pharm.DVIYear, Department of PharmacyPractice, School of PharmaceuticalSciences,VelsInstitute of Science, Technology and Advanced Studies, Pallavaram, Chennai-600117.
Dr.KarthickeyanKrishnan
Professor and Head, Department of Pharmacy Practice, School ofPharmaceuticalSciences, VelsInstitute of Science, Technology and Advanced Studies, Pallavaram, Chennai-600117.