Distal Renal Tubular Acidosis, an Uncommonly diagnosed Cause of Failure to Thrive: Report of Five Cases.

Five cases of distal renal tubular acidosis aged between 2½ weeks and 2½ months are described. The presenting features included lethargy, refusal to feed, high density of periodic respiration, vomiting and recurrent episodes of unexplained metabolic acidosis. A constant feature was failure to thrive despite caloric intakes in excess of normal requirements. The diagnosis of distal renal tubular acidosis (DRTA) was based on a urine pH>5.5 in a freshly voided urine despite concurrent or induced metabolic acidosis. All the babies responded dramatically to sodium bicarbonate supplement, as baking soda or bicarbonate of soda. The need for increased index of suspicion of DRTA in the evaluation of children in early infancy for failure to thrive and the simplicity of treatment using baking soda is discussed. Nigerian Journal of Paediatrics 2001; 28:21. pp. 21-2