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Logo of bmjcrInstructions for authorsCurrent ToCBMJ Case Reports
BMJ Case Rep. 2010; 2010: bcr0420091792.
Published online Jul 12, 2010. doi:  10.1136/bcr.04.2009.1792
PMCID: PMC3034204
Reminder of important clinical lesson
Renal tubular acidosis and superior mesenteric artery syndrome
Sanwar Agrawal,1 Sangeeta Nagraj,1 and Ravi Chaube2
1Department of Paediatrics, Ekta Institute of child health, Raipur, India
2Department of Radiology, Ultracare Diagnostic Centre, Raipur, India
Correspondence to Dr Sanwar Agrawal, drsanwar50/at/
A 12-year-old girl presented with significant vomiting, and generalised muscular weakness. She had normal anion gap metabolic acidosis, hypokalemia and alkaline urine. Vomiting generally leads to metabolic alkalosis but this patient had acidosis which suggested either renal tubular acidosis (RTA) or diarrhoea. Investigations showed distal RTA. There was no family history of similar illness. Abdominal ultrasound showed features of the superior mesenteric artery syndrome, but a barium study showed no duodenal obstruction, making this an unlikely cause of symptoms. Weight loss as a result of the renal condition may have caused loss of mesenteric or retro-duodenal fat and explain the ultrasound appearance.
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