Ceftriaxone sodium is not metabolized in the body. 50-60% of ceftriaxone is excreted by the urinary system as a prototype, and 40-50% is excreted by the biliary tract and digestive tract, therefore, it can lead to gallbladder stones and urinary stones, which can be seen in both adults and children. Theoretically, ceftriaxone sodium has high drug solubility and is not easy to form urinary stones. When blood volume decreases and urinary flow rate decreases and high doses are administered, the drug concentration reaches a peak within a short period of time and ceftriaxone ions form ceftriaxone calcium with calcium ions in urine. Because ceftriaxone calcium is insoluble in water, it then precipitates in the ureteral urine and forms pseudoliths after crystallization. This leads to acute urinary tract obstruction and then acute renal failure. Professor Sun Xizhao found that ceftriaxone calcium was the main component of ceftriaxone stones by infrared spectroscopic analysis of ceftriaxone stones and electron microscopic scanning. The formation of ceftriaxone stones was positively correlated with the concentration of calcium ions and ceftriaxone in urine and negatively correlated with the concentration of citrate in urine. Because children are often unable to express their condition completely, their subjective discomfort is rare and often waits until symptoms are severe or even life-threatening. The diagnosis of these stones is somewhat specific and often has the following characteristics: a relatively rapid onset, a history of ceftriaxone sodium use before the onset, and the earliest onset of symptoms about 1-2 days after the use of the drug, mostly within 7 days. Urological ultrasonography may reveal bilateral hydronephrosis, mud-like strong echogenicity, and mostly negative stones on urinary tract plain radiographs. The treatment of these stones is based on the rapid relief of obstruction, and the first choice is ureteroscopic double-J tube placement, which is done under the guidance of a catheter or guidewire to avoid the formation of a false channel because the ureteral wall is prone to perforation due to edema. The stones are usually small in diameter or sediment-like, sometimes in the form of white loose flocculent accumulations that fill most of the ureter, and can be crushed by ureteral catheterization or holmium laser. Depending on the patient’s condition, the rate of complete lithotripsy should not be overly pursued, and rapid relief of obstruction should be the main focus. Therefore, when using ceftriaxone drugs, attention needs to be paid to avoid high concentration, high dose and long time use, pay attention to low calcium diet and discontinue calcium preparations, and attention needs to be paid to hydration. Beijing Friendship Hospital has dealt with 3 cases of pediatric urinary stones caused by ceftriaxone, and more than 160 cases have been reported in China, but the actual incidence is much higher due to lack of awareness and testing conditions! Since such stones have a great impact on pediatric health and are of medical origin, such urinary stones are preventable and treatable as long as medical personnel are fully aware of the disease and alert to high-risk children!