# Severe growth faltering and persistent hyperchloremic metabolic acidosis as early clues of renal tubular acidosis in a neonate: a case report

## TL;DR

A neonate with severe growth issues and acidosis was diagnosed with renal tubular acidosis, highlighting the importance of early detection in resource-limited settings.

## Contribution

This case report highlights the early signs of renal tubular acidosis in neonates in resource-limited settings.

## Key findings

- A neonate presented with growth faltering and metabolic acidosis, leading to a diagnosis of proximal renal tubular acidosis.
- Persistent hyperchloremic acidosis despite diarrhoea and septic shock indicated underlying renal dysfunction.
- Early diagnosis and treatment are crucial to prevent complications like electrolyte disorders and bony deformities.

## Abstract

Renal tubular acidosis (RTA) often presents as failure to thrive in children. In a resource-limited country, the diagnosis of renal tubular acidosis can be delayed or even missed because of the co-existing high burden of malnutrition. Here we report a case of a neonate/infant who presented with diarrhoea and failure to thrive and subsequently developed septic shock. During the management of the child, proximal renal tubular acidosis was diagnosed based on the persistence of metabolic acidosis with hyperchloremia. Proximal renal tubular acidosis (pRTA) can lead to complications, such as electrolyte disorders, bony deformities. Prompt diagnosis, appropriate treatment, and long-term follow-up are imperative for achieving good outcomes.