Salt-losing crisis in infants-not always of adrenal origin

Bharathi Pai, Nick J Shaw, Wolfgang Högler

Research output: Contribution to journalArticlepeer-review

8 Citations (Scopus)


UNLABELLED: Three infants (age 1.5, 4 and 7 months) presented with vomiting, hyponatremia and hyperkalaemia suggestive of a salt-losing congenital adrenal condition. Diagnostic endocrine bloods were taken and adrenal steroid therapy was started. The infants were subsequently found to have raised plasma aldosterone and renin levels due to pyelonephritis and structural anomalies of the kidneys, demonstrating secondary aldosterone resistance.

CONCLUSION: Establishing the diagnosis of congenital adrenal disorders is essential in a baby who develops a salt-losing crisis in the first few weeks of life. However, pyelonephritis should be considered and can be rapidly excluded in any infant presenting with a salt-losing crisis with hyponatremia and hyperkalaemia, in particular, outside the neonatal period. Only then should an endocrine cause for this presentation be considered and treatment commenced.

Original languageEnglish
Pages (from-to)317-21
Number of pages5
JournalEuropean Journal of Pediatrics
Issue number2
Publication statusPublished - Feb 2012


  • Diagnosis, Differential
  • Escherichia coli Infections
  • Female
  • Humans
  • Hyperkalemia
  • Hyponatremia
  • Infant
  • Kidney
  • Klebsiella Infections
  • Klebsiella oxytoca
  • Male
  • Pseudohypoaldosteronism
  • Pyelonephritis
  • Streptococcal Infections
  • Vomiting
  • Case Reports
  • Journal Article


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