431 GOAT'S MILK ACIDOSIS

Abstract

Faced with a generation of parents reared in an era of food fads and special diets, physicians must remain alert for strange diets and their consequences on children of various ages. We recently evaluated a 3 week old infant with hyperchloremic metabolic acidosis and failure to thrive which was directly attributable to undiluted goat's milk feedings. This term infant presented with severe tachypnea.Serum electrolytes in mEq/1 were Na 131 K 6, Cl 116, CO₂ 4. Serum pH was 7.14, Hb 16.8 gm%. Serum values in mg/dl were BUN 30, Cr 0.4, Ca 10.6, PO₄ 8.1. Urine pH was 5.0 Upon withdrawal of the goat's milk and after 12 hours of intravenous fluid therapy, the infant's clinical condition improved. By 48 hours, the serum electrolytes were normal. After 10 days of sustained weight gain on commercial formula, goat's milk was reintroduced. Within 18 hours, the baby lost weight and developed tachypnea and laboratory evidence of a compensated metabolic acidosis. Goat's milk was discontinued and his symptoms quickly resolved. Goat's milk is high in protein, potassium, chloride, phosphorus and calcium. On this milk, the infant's net acid excretion increased and was largely attributable to an increase in ammonium excretion. This response is similar to that seen in patients loaded with hydrochloric acid. The admission blood values reflect the composition of goat's milk. We suggest that undiluted goat's milk is an inappropriate food source for infants during the first month of life.