Rickets Secondary to Renal Tubular Acidosis - A Case Report

This case study presents a 2-year-old female patient admitted to the paediatric High Dependency Unit (HDU) with symptoms including fever, cough, breathing difficulty, and recent loose stool. Clinical examination revealed severe dehydration and signs of metabolic acidosis characterized by hyperglycaemia and acidotic breathing. Initial management involved fluid resuscitation, mechanical ventilation in Synchronized intermittent mandatory ventilation (SIMV) mode, and insulin therapy. Arterial blood gas analysis indicated hyperchloremic normal anion gap metabolic acidosis, while urine ketone testing was negative. Laboratory investigations revealed severe hypokalaemia, alkaline urine pH, and hypercalciuria. Imaging studies, including X-ray and ultrasonography (USG KUB), showed bilateral nephrocalcinosis and features suggestive of rickets in the long bones. Treatment included conservative measures such as oral potassium chloride syrup, oral sodium bicarbonate, and intravenous amikacin. Continuous monitoring of renal function tests, electrolytes, and arterial blood gases was conducted, leading to clinical improvement and eventual discharge.