EC Paediatrics

Introduction: In clinical practice, hydroelectrolytic and acid-base state imbalances are very common. In the presence of several alterations at the same time, it is important to consider the patient’s medical history, and his or her basic disease, if any, and prioritize what to correct first.

In patients with ureterosigmoidostomy, the main complication is hyperchloremic metabolic acidosis. Other associated alterations are hypomagnesemia, hypocalcemia, hyperammonemia and increased creatinine and blood urea.

Long-term follow-up is important for early diagnosis and treatment, thus avoiding serious life-threatening complications.

Objective: To describe a clinical case with multiple electrolyte disturbances of difficult correction and focus on the management of these disturbances.

Description: A 14-year-old female adolescent seeks medical assistance due to vomiting and diarrhea for 48 hours. A laboratory study was performed, and multiple electrolyte disorder was found.

Diagnosis: Hypernatremic dehydration, hyperchloremic metabolic acidosis with acidemia, hypokalemia without electrocardiographic repercussion, hypophosphatemia, and hypomagnesemia associated with muscle aches and spasms (that required IV fluids treatment), and exacerbation of chronic renal failure in the patient, with Rokitansky syndrome and ureterosigmoidostomy.

Conclusion: The proper correction of the internal environment stabilized the patient; this was a challenge when deciding what to correct first, in the face of multiple electrolyte disturbances.

Keywords: Electrolytes; Acid-Based; Ureterosigmoidostomy

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