The role of chloride deficiency in the generation of hypokalemic metabolic alkalosis with elevated plasma renin activity and plasma aldosterone levels, normal blood pressure, and a renal concentrating defect was studied in six infants given a soy formula that was deficient in chloride. A deceleration in linear growth, weight gain, and head circumference with age and delayed neurologic development were noted in every infant during the first six months of life. Microscopic hematuria and persistent elevation of plasma creatinine were noted in four of the infants. A renal biopsy in two infants revealed no juxtaglomerular hyperplasia, but interstitial tubular calcification was observed in one, and interstitial fibrosis was found in both. The generation of the hypokalemic metabolic alkalosis in these infants was explained by the reduced intake of chloride, and the addition of chloride alone to the diet resulted in a correction of the electrolyte abnormalities and the alkalosis.

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