Neo-Mull-Soy metabolic alkalosis: a model of Bartter's syndrome?

A case of Neo-Mull-Soy-induced metabolic alkalosis occurred in an 8-month-old child. This child had hypochloremic hypokalemic alkalosis as well as hyperreninemia. Initially, a diagnosis of Bartter's syndrome was made and treatment consisted of KCl replacement, indomethacin, and aspirin. In retrospect, the diagnosis of Neo-Mull-Soy induced metabolic alkalosis could have been suspected on the basis of the low chloride concentration in his urine. Proposed mechanisms for the etiology of Bartter's syndrome are reviewed. Neo-Mull-Soy induced metabolic alkalosis simulates Bartter's syndrome and supports the concept that the primary abnormality in Bartter's syndrome is chloride deficiency. The chloride deficiency in Bartter's syndrome results from a defect in active chloride transport in the thick ascending limb of the loop of Henle.

Strangulation of the uvula by hair wrapping.

A 13-month-old male presented with a hair wrapped around his uvula. The entwined hair subsequently caused autoamputation of the distal uvula. Although a non-accidental etiology has been suggested for some cases of hair strangulation of appendages, this case indicates accidental strangulation of body parts is possible.

Hodgkin's disease presenting as renal failure: improvement in renal lesion and renal function with chemotherapy.

A 15 year old girl presented with weight loss, lymphadenopathy and severe renal failure. A diagnosis of Hodgkin's disease were made by biopsy of a lymph node. Renal biopsy findings included diffuse infiltration of the interstitium by lymphocytes and plasma cells. There was a mild increase in mesangial matrix in the glomeruli. Renal function returned to normal after she received chemotherapy for the Hodgkin's disease. This improvement was associated with a significant decrease in the renal interstitial infiltrate and by a significant decrease in the renal size on intravenous pyelography. It is unusual for patients with Hodgkin's disease to present in renal failure. We are unaware of any previous patient who presented in this manner and who survived with normal renal function. The patient is now apparently free of disease six years after her original illness.

Rhabdomyolysis associated with acute varicella infection.

We report two cases of intense, generalized rhabdomyolysis complicating varicella-zoster virus (VZV) infections, one in an adolescent and one in a young adult male. In both cases, myoglobinuria and weakness of large muscle groups developed within 5 days of the onset of vesicular lesions. A muscle biopsy from one of the individuals showed muscle fiber necrosis in the absence of acute inflammatory infiltrates or vasculitis. Culture of the muscle biopsy specimen for VZV was negative; however, the VZV genome was detected by the polymerase chain reaction. Both patients recovered fully after treatment with hydration therapy alone.