Patient is an 8 year-old female with HPN dependence due to short bowel syndrome. She has high ostomy due to proximal stoma. Height velocity gradually slows over the last 12 months. Receiving adequate calorie and fluid support. Compliance has been assessed to be satisfactory. On history, parents report she especially craves pickles and French fries (salty foods).
What is the next step?
A. Increase PN calories.
B. Reassurance that patient is undergoing pubertal growth spurt.
C. Check serum and urine electrolytes. Consider increasing PN sodium provision.
D. Refer to the local emergency department for bacteremia work-up.
E. Check liver ultrasound.
The correct answer is c. The biochemical basis for the effect of sodium deficiency on growth is unknown. However, several clinical studies have linked sodium and growth. Additionally, patients with ileostomies are at risk of sodium depletion and impaired growth. The optimal way to assess sodium adequacy is 24-hour urine collection compared with intake or fractional excretion of sodium (FENa). More often, urine electrolytes are checked. Less than 10 mmol/L is considered abnormal and levels less than 30 mmol/L may interfere with growth.
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