Pediatric Nephrology Expert Opines on Delayed Treatment of Renal Failure

This case involves a 10-year-old boy who presented to the ER with complaints of nausea, vomiting, fever, and swelling of his lower limbs. The patient was discharged with over the counter painkillers as well as instructions to maintain fluid intake. The patient returned to the ER several days later with complaints of the same symptoms. At this point, he was admitted and treated for apparent dehydration with IV fluids. Due to a clerical mistake made by hospital staff, the patient was overloaded with fluid, and was given diuretics to correct this. A short time later, the patient was seen by a pediatric nephrologist who diagnosed him with syndrome of inappropriate antidiuretic hormone secretion, in which abnormal hormone levels cause the body to retain excess water. Later, the patient was also diagnosed with, and treated for, compartment syndrome. Despite treatment, the patient expired while in the hospital, and an autopsy determined the cause of death to be acute renal failure.

Question(s) For Expert Witness

1. Do you treat pediatric patients with acute renal failure? If so, how often?

Expert Witness Response E-007688

I really would like to look at this tragic case. I am a Pediatric Nephrologist with considerable experience treating renal failure. The diagnosis of syndrome of inappropriate ADH secretion may have been inappropriate here, and is usually an unlikely diagnosis given this patient's course and medical history. Regardless, earlier identification of the issue, as well as proper treatment once the issue was identified, could possibly have prevented this unfortunate outcome.

Expert Bio

This double board certified expert has been practicing for nearly 30 years. He completed his Pediatrics residency at the Children's Hospital of Philadelphia, one of the nation's leading children's hospitals, where he also competed multiple fellowships in Endocrinology/Diabetes. He is a Fellow of the American Academy of Pediatrics and has published over 50 peer-reviewed articles. He serves as a reviewer for 9 scientific journals such as "Journal of Pediatrics" and "Journal of Clinical Endocrinology and Metabolism" and in the past has been named to both Best Doctors in America and Marquis' Who's Who in America. Currently, this expert is an Associate Professor of Pediatrics at a major medical university and the Director of the Diabetes Center at his institution's affiliated children's hospital.