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appropriately. Silver nitrate was previously the first line of treatment of this condition in our local hospital. However,it is associated with various problems which include burns to the surrounding skin and need to be applied by a trained health professional.Salt treatment was introduced to our local hospital as the first line treatment for umbilical granulomas. Salt is thought to be effective due to it's desiccant properties. The salt is applied and monitored by our outreach nursing team after the diagnosis is confirmed. Salt is applied to the area for 30 minutes after it has been cleaned. Further application of salt is done by the parents twice daily after they have been trained. On the 4th day of treatment, the granuloma is assessed by the team at home. No further treatment is required if it has resolved completely. In cases of treatment failure, further treatment with polyurethane and silver nitrate is considered as per local policy. Objectives A retrospective audit was undertaken to demonstrate the effectiveness of salt therapy as the first line of treatment for umbilical granulomas. Methods A review of the case notes of the infants treated for umbilical granuloma between January 2019 and November 2020 in our trust was done. A proforma was created reviewing what treatment the infants received. Results A total of 6 infants received salt treatment as the first line of treatment for their umbilical granulomas during the review period. The umbilical granulomas resolved completely with salt treatment after a 3 day course of salt application. No infant during our study period required second line treatment.Conclusions Our audit has demonstrated that salt treatment is an effective, environmentally friendly, inexpensive and easily available first line treatment for umbilical granulomas with no reported side effects.

Hyperkalemia in end stage renal disease patients is a common complication. Sodium polystyrene sulfonate (Kayexalate) is a commonly used in the treatment of hyperkalemia. This case report discusses about Kayexalateinduced colonic necrosis, a rare but fatal complication of this commonly used medication.