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fluid therapy pediatric

Obeid Shafi, Virendra Kumar
INTRODUCTION: The optimal fluid therapy in children with DKA is a matter of debate, especially if we take into account its association with cerebral edema, the most important complication. Hypertonic Saline Solution is used in the treatment of cerebral edema, and also has been used for volume resuscitation in children with shock. AIM OF STUDY: To compare the effects of 3% saline and 0.9% saline solutions on changes in vital parameters, sodium and chloride levels, lactate and pH; time needed for the correction of hyperglycemia; time needed for the control of ketoacidosis and incidence of cerebral edema...
2018: Pediatric Endocrinology, Diabetes, and Metabolism
Carolyne Ghobrial, Engy Adel Mogahed, Hanaa El-Karaksy
Ascitic fluid infection is a major cause of morbidity and mortality in cirrhotic patients, requiring early diagnosis and therapy. We aimed to determine predictors of ascitic fluid infection in children with chronic liver disease. The study included 45 children with chronic liver disease and ascites who underwent 66 paracentesis procedures. Full history taking and clinical examination of all patients were obtained including fever, abdominal pain and tenderness and respiratory distress. Investigations included: complete blood count, C-reactive protein, full liver function tests, ascitic fluid biochemical analysis, cell count and culture...
2018: PloS One
Cory Anderson, Timothy Lynch, Ronish Gupta, Rodrick K Lim
BACKGROUND: Pediatric exposure to prazosin is unusual because it is most commonly indicated for the treatment of hypertension. Prazosin's increase in popularity as a treatment for posttraumatic stress disorder makes it important for emergency physicians to be aware of how to manage potential toxic ingestion because of prazosin overdose. CASE REPORT: A 16-year-old, 76-kg female presented after ingesting 110 mg of prazosin, 209.3 g of acetaminophen, and 55 g of naproxen...
October 1, 2018: Journal of Emergency Medicine
Sedigheh Rafiei Tabatabei, Roxana Azma, Manijeh Kahbazi, Abdonaser Farzan, Maryam Kazemi Aghdam, Kimia Seifi, Negin Nahanmoghaddam
Gram-negative meningitis can occurssubsequent to dura-arachnoid barrier disruption because of trauma, surgery and rarely an infected dermoid cyst. Association of neurosurgical procedures with Gram-negative meningitis was described for the first time in 1940. Intracranial infections from gram-negative bacilli like Enterobacter are serious and difficult to treat as many antibiotics fail to achieve bactericidal concentrations in the cerebrospinal fluid. Here in, we report a rare case of pediatric Enterobacter meningitis in a patient with a dermoid cyst that had been manipulated...
2018: Iranian Journal of Child Neurology
Yajun Zhang, Fenglan Luo, Nini Wang, Yue Song, Yuhong Tao
Objective This study aimed to analyze the clinical characteristics and prognosis of pediatric idiopathic pulmonary hemosiderosis (IPH). Methods Pediatric IPH cases that were diagnosed at West China Second University Hospital, Sichuan University between 1996 and 2017 were reviewed. Follow-up data from 34 patients were collected. Results A total of 107 patients were included (42 boys and 65 girls). The median age was 6 years at diagnosis. The main manifestations of the patients were as follows: anemia (n = 100, 93...
October 2, 2018: Journal of International Medical Research
Yasuo Aihara, Sinichiro Watanabe, Kosaku Amano, Kana Komatsu, Kentaro Chiba, Kosuke Imanaka, Tomokatsu Hori, Takashi Ohba, Hitoshi Dairoku, Yoshikazu Okada, Osami Kubo, Takakazu Kawamata
OBJECTIVE: Placental alkaline phosphatase (PLAP) in CSF can provide a very high diagnostic value in cases of intracranial germ cell tumors (GCTs), especially in pure germinomas, to the level of not requiring histological confirmation. Unlike other tumor markers, reliable data analysis with respect to the diagnostic value of PLAP serum or CSF levels has not been available until now. This is the first systematic and comprehensive study examining the diagnostic value of CSF PLAP in patients with intracranial GCTs...
September 28, 2018: Journal of Neurosurgery
Fatih Gürbüz, Mehmet Taştan, İhsan Turan, Bilgin Yüksel
Inappropriate ADH syndrome (SIADH) may develop after intracranial surgery. SIADH in pediatric age is mostly seen in intracranial mass and not only after surgery. The management of these clinical conditions in patients is important for the clinical course of the patient. Fluid restriction is standard therapy in SIADH. Resistant hyponatremic pattern may be encountered in some cases. Vaptans have recently started to be used in hyponatremia due to SIADH. A patient with SIADH of triphasic episode presented to our clinical practice after surgery of craniopharyngioma...
September 27, 2018: Journal of Clinical Research in Pediatric Endocrinology
Anthony P Y Liu, Julie H Harreld, Lisa M Jacola, Madelyn Gero, Sahaja Acharya, Yahya Ghazwani, Shengjie Wu, Xiaoyu Li, Paul Klimo, Amar Gajjar, Jason Chiang, Ibrahim Qaddoumi
Tectal glioma (TG) is a rare low-grade tumor occurring predominantly in the pediatric population. There has been no detailed analysis of molecular alterations in TG. Risk factors associated with inferior outcome and long-term sequelae of TG have not been well-documented. We retrospectively studied TGs treated or referred for review at St. Jude Children's Research Hospital (SJCRH) between 1986 and 2013. Longitudinal clinical data were summarized, imaging and pathology specimen centrally reviewed, and tumor material analyzed with targeted molecular testing and genome-wide DNA methylation profiling...
September 25, 2018: Acta Neuropathologica Communications
Karin E Thompson, Ramesh M Ray, Shanta Alli, Wenbo Ge, Alyssa Boler, W Shannon McCool, Avtar S Meena, Pradeep K Shukla, Radakrishna Rao, Leonard R Johnson, Mark A Miller, Gabor J Tigyi
Diarrheal disease is a severe global health problem. It is estimated that secretory diarrhea causes 2.5 million deaths annually among children under the age of five in the developing world. A critical barrier in treating diarrheal disease is lack of easy-to-use effective treatments. While antibiotics may shorten the length and severity of diarrhea, oral rehydration remains the primary approach in managing secretory diarrhea. Existing treatments mostly depend on reconstituting medicines with water that is often contaminated which can be an unresolved problem in the developing world...
September 25, 2018: Experimental Biology and Medicine
Anna Eichinger, Alexandra Hagen, Melanie Meyer-Bühn, Johannes Huebner
BACKGROUND: Sepsis-like illness with suspected meningitis or encephalitis is a common reason for using empiric antimicrobial therapy in infants and children. However, in cases of viral meningitis not covered by these antimicrobials, this management is ineffective and due to side effects potentially harmful. METHODS: A retrospective analysis of cerebrospinal fluid (CSF) multiplex PCRs (Biofire FilmArray® ) in children with clinical suspicion of meningitis, encephalitis or sepsis-like illness was performed over the period of 1 year...
September 5, 2018: Infection
Avinash N Medsinge, Fernando A Escobar, Sabri Yilmaz, James K Park, John J Crowley
Mediport (also known as port, portacath or Infusaport) is a commonly placed central venous access in pediatric patients. Fibrin sheath formation around the central venous catheter is a common biological response leading to port malfunction in the form of inability to aspirate but preserved capacity for infusion of fluids. If fibrinolytic therapy fails, percutaneous fibrin sheath stripping via transfemoral route or replacement with a new mediport are routine/conventional treatments for a fibrin sheath. We describe a novel technique for removing a fibrin sheath by exteriorizing the catheter through the neck entry site, stripping the fibrin sheath from the catheter manually under sterile conditions and replacing the catheter via a peel-away sheath introduced through the same skin incision as an alternative to complete port replacement or attempted catheter stripping...
August 29, 2018: Pediatric Radiology
Anna E van Beek, Angela Kamp, Simone Kruithof, Ed J Nieuwenhuys, Diana Wouters, Ilse Jongerius, Theo Rispens, Taco W Kuijpers, Kyra A Gelderman
Complement is activated as part of the innate immune defense against invading pathogens. Also, it helps to remove apoptotic debris and immune complexes from the circulation. Impaired complement function due to aberrant plasma levels of complement proteins may be indicative for complement-mediated diseases or can be involved in susceptibility for infections. To determine whether plasma levels are abnormal, reference intervals (RIs) are used from adult healthy donors. Since many complement-mediated diseases have an onset during childhood, it is important to know whether these RIs can be extrapolated to children...
2018: Frontiers in Immunology
Tareq Al-Ayed, Naveed Ur Rahman, Abdullah Alturki, Fahad Aljofan
BACKGROUND: Continuous renal replacement therapy (CRRT) has become the preferred mode of dialysis to support critically ill children with acute kidney injury. However, there are limited pediatric data on CRRT use, especially in our region. OBJECTIVE: Determine the outcome of CRRT among critically ill children. DESIGN: Retrospective cohort study. SETTING: Pediatric intensive care unit. PATIENTS AND METHODS: The study included critically ill children 1-14 years of age who underwent CRRT from July 2009 to June 2015...
July 2018: Annals of Saudi Medicine
Shunpei Okochi, Eva W Cheung, Sunjay Barton, Ariela Zenilman, Aqsa Shakoor, Cherease Street, Svetlana Streltsova, Christine Chan, Michael P Brewer, William Middlesworth
OBJECTIVES: Hemolysis is a known complication of pediatric extracorporeal membrane oxygenation associated with renal failure and mortality. We sought to identify predictors of hemolysis in pediatric extracorporeal membrane oxygenation patients and determine its influence on outcomes. DESIGN: Retrospective, single-center study. SETTING: Urban, quaternary care center pediatric and neonatal ICU. PATIENTS: Ninety-six patients requiring extracorporeal membrane oxygenation...
July 27, 2018: Pediatric Critical Care Medicine
Katherine Harer, Jennifer Mann, Nicole Muhlbauer, Jennifer Welch, Brian Alverson
We present the case of a 16-year-old girl who presented with severe refractory orthostatic hypotension secondary to pandysautonomia. Initially, she was treated for Guillain-Barré syndrome given clinical symptoms and increased protein on cerebrospinal fluid, but the severity of symptoms and lack of response to intravenous immunoglobulin prompted further evaluation for an autoimmune etiology. She was ultimately diagnosed with paraneoplastic neuropathy secondary to Hodgkin lymphoma. Paraneoplastic neurologic phenomena are rare, occurring in just 0...
July 24, 2018: Pediatric Emergency Care
Francesco Pichi
PURPOSE: To report a case of pediatric vascularized sarcoid choroidal granuloma complicated by placoid-like inflammation. METHODS: Case report. RESULTS: A 10-year-old girl presented with blurry vision in her right eye and a yellowish macular lesion that had been diagnosed as fibrotic choroidal neovascular membrane and observed for several months. On referral to our clinic, optical coherence tomography revealed a homogeneous hyperreflective lesion obliterating the choroidal vasculature and protruding under the retina with associated subretinal and intraretinal fluid...
July 24, 2018: Retinal Cases & Brief Reports
Hiroshi Hataya
BACKGROUND: Recent statistics have revealed that the number of patients with preemptive kidney transplant (KTx) has increased to 21.9% between 2006 and 2011. However, factors like body height, lack of kidney source, and severe complications render some patients ineligible for KTx. Peritoneal dialysis (PD) acts as the bridging therapy to KTx, especially for infants and young children. Because the period of PD treatment is relatively longer in Japan due to the lack of kidney donors, management of PD is imperative for the success of the treatment...
2018: Contributions to Nephrology
Adil R Dingankar, Dominic A Cave, Vijay Anand, V Ben Sivarajan, Susan Nahirniak, Cathy Sheppard, Jan Hanot, Gonzalo Garcia Guerra
OBJECTIVES: To determine the clinical benefit of using colloids versus crystalloids for volume resuscitation in children admitted after cardiac surgery. DESIGN: Retrospective pre-/postintervention cohort study. SETTING: Stollery Children's Hospital tertiary care pediatric cardiac ICU. PATIENTS: Children admitted to the pediatric cardiac ICU after cardiac surgery. INTERVENTIONS: Fluid resuscitation policy change in which crystalloids replaced albumin 5% as the primary fluid strategy for resuscitation after cardiac surgery...
September 2018: Pediatric Critical Care Medicine
Gabriella S Lamb, Coralee Del Valle Mojica, Nivedita Srinivas, Jeffrey Starke
A 4-year-old former 24-week gestation male and an 18-month-old former 26-week gestation female, both with history of intraventricular hemorrhage resulting in hydrocephalus, presented with Mycobacterium abscessus ventricular shunt infections affecting both the shunt track and the ventricular fluid. Both children required prolonged combination antimycobacterial therapy; the 4 year old required more than two months of triple intravenous antibiotics and intraventricular amikacin to sterilize the cerebrospinal fluid...
July 11, 2018: Pediatric Infectious Disease Journal
Felice D'Arco, Sinead Culleton, Laurens J L De Cocker, Kshitij Mankad, Jorge Davila, Benita Tamrazi
Pediatric brain tumors differ from those in adults by location, phenotype and genotype. In addition, they show dissimilar imaging characteristics before and after treatment. While adult brain tumor treatment effects are primarily assessed on MRI by measuring the contrast-enhancing components in addition to abnormalities on T2-weighted and fluid-attenuated inversion recovery images, these methods cannot be simply extrapolated to pediatric central nervous system tumors. A number of researchers have attempted to solve the problem of tumor assessment during treatment in pediatric neuro-oncology; specifically, the Response Assessment in Pediatric Neuro-Oncology (RAPNO) working group was recently established to deal with the distinct challenges in evaluating treatment-related changes on imaging, but no established criteria are available...
July 6, 2018: Pediatric Radiology
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