Treatment:
She received hypertonic saline (1 ml/ kg /hour) for 48 hours, proton
pump inhibitor, in addition to fluid and salt restriction strategy.
After 24 hours, her serum sodium rose to 119 mmol/L and after 48 hours,
it rose further to 130mmol /L. Vomiting and irritability disappeared
after 24 hours of starting the hypertonic saline. She also received
injectable ciprofloxacin as her urine culture disclosed growth of
E-coli. Besides, the patient has transfused three units of packed cell
blood transfusion and received thyroxine 25 mcg OD and allopurinol 100
mg OD. Her readings of blood pressure were static at 140/ 90 for 3
consecutive days, so we decided to start ACEI (Lisinopril 2.5mg OD).
Genetic counselling and the possibility of renal replacement therapy
were discussed with her family.
Outcome and follow-up : Patient discharged in good conditions on
day 5, her parameters of red blood cells were improved: HGB was 9 g/dl,
and serum sodium 135mmol /L; she was discharged on erythropoietin,
1-Alfacalcidol, folic acid, iron, calcium carbonate, thyroxine,
Lisinopril and allopurinol.
During her last follow up in Gezira hospital for renal disease and
surgery, the patient was free of symptoms; her haemoglobin 11 /mg dl;
blood urea was 70 mg/ dl and creatinine 3 mg/ dl. Her blood pressure
150/90, the dose of ACEI pushed up to 10 mg.