Virginia H. Peden

Copper deficiency in long-term parenteral nutrition

An infant with ileal atresia and a postoperative short bowel syndrome was maintained intermittently for the first 8 1/2 months of life by total parenteral nutrition. At 7 1/2 months of age she developed signs of copper deficiency which responded promptly to copper supplementation. This rare dietary deficiency is the first reported during the course of total parenteral nutrition.

Total parenteral nutrition in premature infants

Thirteen premature infants, unable to tolerate conventional feeding, were given totalparenteral nutrition by central venous catheter. The infusate contained 3.3 per cent beef fibrin hydrolysate, 20 per cent glucose, electrolytes, and vitamins. Eight infants survived, six of whom weighed less than 1,500 Gm. Nitrogen retention was equal to that reported for full-term infants fed orally. Weight gain of appropriate-for-date infants was similar to that reported for premature infants fed orally, but weight gain of small-for-date infants lagged behind. Data concerning sodium and potassium balance and the tolerated rates of glucose infusion are reported, and problems encountered are discussed. The method is feasible for nourishing selected premature infants.

Differentiation of chronic lymphocytic thyroiditis and simple goiter in pediatrics

Eighty-one children with goiter were studied. Thirty-five had open biopsies and 23 of these patients had one or more simultaneous needle biopsies. In the remainder, the diagnosis was made by clinical and laboratory findings. Of 35 biopsied patients, the histologic diagnosis was chronic lymphocytic thyroiditis (CLT) in 22 and simple goiter in 13. Needle biopsy proved inadequate for diagnosis in 40 per cent. In biopsied patients, thyroid antibody studies by the tanned red cell technique were positive with a titer of 1:16 or greater in only a few cases of CLT. An immunofluorescent technique revealed antibodies in 100 per cent of cases of CLT and was negative in all cases of simple goiter. A difference between protein-bound iodine and thyroxine >2.0 μg per cent was found in almost as many cases of simple goiter as in CLT. Clinical and laboratory findings are reported for the entire group of 81 patients.

Disseminated Intravascular Coagulation Complicating Propylthiouracil Therapy A Case Description of a 16-Year-Old Girl

A 16-year-old girl with thyrotoxicosis, treated successfully for two years with propylthiouracil, developed a purpuric rash, prolonged pro- thrombin time, increased split fibrin products, elevated antinuclear anti body titer and glomerular changes. The symptoms abated after ther apy with heparin and prednisone, although the ANA titer remained elevated. This is presented as the first reported instance of dissem inated intravascular clotting resulting from propylthiouracil therapy.

453 SALT WASTING WITH POSTERIOR URETHRAL VALVES

Clinical manifestations of posterior urethral valves (PUV) may vary widely. Biochemical abnormalities have not been emphasized. Seven male infants (mean age 6 weeks, range 9 days to 6 months), seen over a ten year period, presented with laboratory evidence of salt wasting suggesting adrenal insufficiency. Admission sodium, potassium, BUN, creatinine, serum pH, and urine pH and specific gravity were recorded. When available simultaneous urine and serum electrolytes were noted. In all cases PUV were confirmed by voiding cystourethrogram. The mean sodium on admission was 117 ± 11 mEq/L (range 95-127) while the mean potassium was 7.9 ± 1.3 mEq/L (range 6.5-9.6). The BUN and creatinine were 76 ± 42 mg/dl (range 27-136) and 3.7 mg/dl (range 2.2-5.8) respectively. The mean specific gravity of the urine was 1.007 ± .004 (range 1.005-1.017). In four patients simultaneous serum and urine electrolytes were determined. The mean serum sodium was 132 while the mean urine sodium was 9.25 mEq/Kg/L. All of the patients manifested an impaired ability to conserve water and sodium. In addition, an impaired ability to excrete acids into the urine resulted in acidosis and hyperkalemia. The sodium, potassium, water and acid imbalance is not due to aldosterone deficiency but reflects a glomerulus-tubular dysfunction.Infants presenting with hyponatremia and hyperkalemia who have a very high BUN should have a urethral catheter implaced and a diagnosis of PUV ruled out.