Indries, Priscillaand Dr. Mary Lousia Brubaker

Title:
An 11-month-old Female with Pink Diaper Syndrome

Abstract:
An infant with dehydration may present to primary care with a parent complaint of seeing “blood” in their child’s diaper. Hematuria is a concern, but another possibility is uric acid crystal precipitate. These benign orange-red crystals may be interpreted as hematuria which can cause heightened fear for the parents. Twenty-two percent of breastfed infants in their first week of life experience uric acid crystals in their diaper. However, if the discoloration persists it may be more serious conditions such as Lesch-Nyhan disease, Citrobacter sedlakii infection, or hematuria.
An 11-month-old female was referred to the urology clinic by a pediatric ED for a recent URI diagnosed 12 days prior, suspected hematuria, and elevated urinary ketones of 3mg/dL. During the initial outpatient consultation, her URI and “hematuria” had resolved. A renal bladder ultrasound (RBUS) and U/A were obtained for further workup, revealing normal results. Physical examination showed a well-nourished infant with no indications of trauma. The patient’s father presented a phone image of her diaper with the “hematuria” revealing a one 6 cm streak that was brick-dust like in color.
This case illustrates the differential needed for a “bloody” diaper while alleviating the fears of the parents and possible unnecessary testing. While the image provided additional information, teaching the parents the value of bringing the diaper to the provider permits the possibility of a diagnosis of uric acid crystals. The diagnosis of “pink diaper syndrome” can be supported when a gloved provider can finger grind the dried crystals into a fine powder.

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