Metabolic alkalosis in cystic fibrosisA 3 month old male infants with two earlier episodes of respiratory infection presented with respiratory symptoms, cianosis, hyponatremia, hypokalemia, hypochloremia, metabolic alkalosis, and normal renal function tests. Quantitative determinations of sweat electrolytes in three samples showed elevated Na + (x 62.6 mEq/L) and Cl (83.9 mEq/L) concentrations, together with high plasma renin activity (30 ng/mL x h, normal: 1-2,5 ng/mLx h). Excesive Na + loses and depletion probably explain high renin activity, aldosterone secretion and the occurrence of metabolic alkalosis in this patient. Cystic fibrosis must be included in the differential diagnosis in children with unexplained metabolic alkalosis and recurrent respiratory symptoms. (Key words: cystic fibrosLs, metabolic alkalosis.} La fibrosis quistica del pancreas es una enfermedad hereditaria que compromete principalmente a nines, adolcscentes y adultos jovenes y que se caracteriza por un trastorno funcional generalizado de las glandulas exocrinas.La presencia de enfermedad pulmonar cronica, deficicncia pancreatica y concentraciones anormalmente altas de electrolitos en el sudor constituyen la clasica triada de presentation 1 , aunque se sabe que no siempre es afectado el pancreas, el compromiso respiratorio esta presentc en la gran mayoria de los pacientes y es causa importante de muerte 2 .Mucho menos frecuente es la presencia de otro tipo dc alteraciones, como por ejemplo del equilihrio acido-base y eleetrolitico. En estos enfermos se produce una alcalosis metabolica y concentraciones bajas de electrolitos sanguineos 3 , lo que puede inducir al planteamiento de diversos diagnosticos, si es que no se tiene el antecedente de la existencia de fibrosis qui'stica en un determinado pacicnte.Sc describe a continuation el caso de un lactante con alcalosis metabolica hiponatrernica, hipokale"mica e hipocloremica y en el cual se comprobo el diagnostico de fibrosis quistica del pancreas.

The clinical records of fourteen children discharged with the diagnosis of tuberculous (TB) meningitis from a metropolitan hospital at Santiago, Chile, were reviewed: Nine patients (64%) were under 5 years, but all were older than 12 month of age, eight (57%) had positive history of exposure to TB, even though this information was not always easy to obtain and five (36%) had BCG scars. Mycobacterium tuberculosis was isolated from the cerebrospinal fluid of 5 patients (36%). Other four patients had miliary spread of the disease associated to the meningeal infection. The most frecuent laboratory finding was low chloride concentration in the cerebrospinal fluid (CSF). Secuelae occurred in 11 patients (79%), consisting in hidrocephalus in 7. A clear correlation was observed between secuelae and the amount of time elapsed from admission to the begining of the specific antibacterial therapy. BCG scar does not exclude the diagnosis of TB meningitis. In patients presenting with meningoencephalic symptoms, motor involvement, cranial nerve palsies and low CSF chloride levels the diagnosis of TB meningitis must be considered. (

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