Primary adrenal insufficiency Quiz: Ace Your Exams

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A 2-week-old male is brought to the emergency department due to vomiting and lethargy. The patient has had several days of difficulty feeding, frequent spitting, and poor weight gain. His mother is worried that he might be dehydrated. The patient was born at home and did not have any prenatal screening performed. Temperature is 37.0°C (98.6°F), pulse is 182/min, respirations are 70/min, blood pressure is 40/palp mmHg, and oxygen saturation is 93% on room air. On physical exam the infant has poor tone, sunken fontanelles, and dry mucous membranes. Initial laboratory findings are demonstrated below:  
 
 Laboratory Value  Result  Reference Range 
 Serum chemistry  
 Sodium   124 mEq/L  136-146 mEq/L 
 Potassium   5.4 mEq/L  3.5-5 mEq/L 
 Chloride   95 mEq/L  95-105 mEq/L 
 Creatinine   1.2 mg/dL  0.6-1.2 mg/dL 
 Glucose  37 mg/dL  70-110 mg/dL 
   
Which of the following additional findings is most likely to be present in this patient? 

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