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Case Reports
. 2025 Aug 3;17(8):e89285.
doi: 10.7759/cureus.89285. eCollection 2025 Aug.

Life-Threatening Hyponatremia, Hyperkalemia, and Shock in Infancy: Not Always Congenital Adrenal Hyperplasia

Wai Hung Chung  1 , Manson Chon In Kuok  1 , Kwai Yu Winnie Chan  1
Affiliations
Case Reports

Life-Threatening Hyponatremia, Hyperkalemia, and Shock in Infancy: Not Always Congenital Adrenal Hyperplasia

Wai Hung Chung et al. Cureus. .

Abstract

Hyponatremia and hyperkalemia, though uncommon in infancy, are potentially life-threatening electrolyte disturbances. We discuss a case of secondary pseudohypoaldosteronism (PHA) in a six-month-old male presenting with recurrent vomiting, severe hyponatremia (119 mmol/L), hyperkalemia (6.6 mmol/L), and metabolic acidosis (bicarbonate: 9 mmol/L). The patient's condition rapidly deteriorated with hypotension and respiratory distress requiring intensive care and mechanical ventilation. Investigations identified an Escherichia coli urinary tract infection (UTI), and further laboratory tests revealed markedly elevated serum renin and aldosterone levels, consistent with secondary PHA associated with UTI in infancy. This report explores the incidence, proposed pathophysiology, and management strategies for secondary PHA. Additionally, we provide information to aid in differentiating among the potential causes of similar biochemical abnormalities, including congenital adrenal hyperplasia (CAH), in pediatric patients.

Keywords: congenital anomalies of the kidney and urinary tract (cakut); hyperkalemia; hyponatremia; pseudohypoaldosteronism; urinary tract infection.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

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