{
  "abstract": "A 4-month-old previously healthy, exclusively breast-fed male infant presented to the emergency department with severe tachypnoea and respiratory distress requiring intubation for transfer. Arterial blood gas revealed profound metabolic acidosis (pH 6.98) with markedly elevated lactate (18–20 mmol/L), low PaCO2 (16 mm Hg) and concomitant hypoglycaemia (34 mg/dL), suggesting a primary metabolic aetiology.",
  "authors": [
    {
      "affiliations": [
        "Pediatric Intensive Care Unit and Trauma Center, Emergency and Intensive Care Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy",
        "Institute of Anesthesia and Intensive Care, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy"
      ],
      "name": "Marco Piastra"
    },
    {
      "affiliations": [
        "Pediatric Intensive Care Unit and Trauma Center, Emergency and Intensive Care Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy",
        "Institute of Anesthesia and Intensive Care, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy"
      ],
      "name": "Ivonne Portaccio"
    },
    {
      "affiliations": [
        "Pediatric Intensive Care Unit and Trauma Center, Emergency and Intensive Care Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy",
        "Institute of Anesthesia and Intensive Care, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy"
      ],
      "name": "Tony Christian Morena"
    },
    {
      "affiliations": [
        "Pediatric Intensive Care Unit and Trauma Center, Emergency and Intensive Care Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy",
        "Institute of Anesthesia and Intensive Care, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy"
      ],
      "name": "Enzo Picconi"
    },
    {
      "affiliations": [
        "Pediatric Intensive Care Unit and Trauma Center, Emergency and Intensive Care Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy",
        "Institute of Anesthesia and Intensive Care, Università Cattolica del Sacro Cuore Facoltà di Medicina e Chirurgia, Rome, Italy"
      ],
      "name": "Giorgio Conti"
    }
  ],
  "title": "Puffy infant suffering from respiratory distress: a clue for visual diagnosis",
  "uid": "7d6186d3-d64b-5091-a54c-caf6851059ef"
}