WBC: white blood cell; Hb: hemoglobin; Hct: hematocrit; Plt: platelet; S.Cre: serum creatinine; Na: sodium; K: potassium; Cl: chloride; Ca: calcium; Mg: magnesium; T-bil: total bilirubin; AST: aspartate aminotransferase; ALT: alanine aminotransferase; Glu (RBS): glucose (random blood sugar); CRP: c-reactive protein; 17-OHP: 17-hydroxyprogesterone.
X-ray erect abdomen was normal as shown in Fig 2. ECG was interpreted to be normal. Ultrasonography of the abdomen and pelvis (Fig 3.1 & 3.2) showed bilateral increased renal echotexture probably due to dehydration and prominent left renal pelvicalyceal system with an anteroposterior diameter of renal pelvis 11mm. The patient was given supportive measures and started on antibiotics to cover possible sepsis but the work-up for sepsis later came back negative. The electrolyte levels on day two showed Na-119 mmol/l, K-6.0 mmol/L. The morning sample for Cortisol drawn at 8 am on day two showed decreased levels of the hormone (60.7 nmol/L). Patient was started on Hydrocortisone 15 mg IV eight hourly with hourly monitoring of vitals. The blood was drawn and sent for 17-hydroxyprogesterone (17-OHP) for suspicion of CAH which was found to be elevated 2.4 nmol/L (normal: 0.06-0.27) indicative of the diagnosis. His glucose and electrolytes were monitored daily while in the hospital, which gradually improved by the seventh day of hospitalization. Further clinical testing was refused by the parents of the child. After the improvement in clinical signs, the patient was discharged home on replacement therapy consisting of oral prednisolone and fludrocortisone acetate. He was followed up after seven days in the outpatient department. His weight had improved, electrolytes were normal and medications were adjusted according to his weight.