Acute Liver Failure In A Term Neonate After Repeated Paracetamol Administration.

Severe hepatotoxicity caused by paracetamol is rare in neonates. We report a case of paracetamol-induced acute liver failure in a term neonate. A 26-day-old boy was admitted with intestinal bleeding, shock signs, slight liver enlargement, coagulopathy, metabolic acidosis (pH=7.21; bicarbonate: 7.1 mEq/L), hypoglycemia (18 mg/dL), increased serum aminotransferase activity (AST=4,039 IU/L; ALT=1,087 IU/L) and hyperbilirubinemia (total: 9.57 mg/dL; direct: 6.18 mg/dL) after receiving oral paracetamol (10 mg/kg/dose every 4 hours) for three consecutive days (total dose around 180 mg/kg; serum concentration 36-48 hours after the last dose of 77 µg/ mL). Apart from supportive measures, the patient was successfully treated with intravenous N-acetylcysteine infusion during 11 consecutive days, and was discharged on day 34. The follow-up revealed full recovery of clinical and of laboratory findings of hepatic function. The paracetamol pharmacokinetics and pharmacodynamics in neonates and infants differ substantially from those in older children and adults. Despite the reduced rates of metabolism by the P-450 CYP2E1 enzyme system and the increased ability to synthesize glutathione--which provides greater resistance after overdoses--, it is possible to produce hepatotoxic metabolites (N-acetyl-p-benzoquinone) that cause hepatocellular damage, if glutathione sources are depleted. Paracetamol clearance is reduced and the half-life of elimination is prolonged. Therefore, a particular dosing regimen should be followed due to the toxicity risk of cumulative doses. This report highlights the risk for severe hepatotoxicity in neonates after paracetamol multiple doses for more than two to three days.32144-

Envenomation caused by dermal contact with larval forms of moths (eurcism) in Campinas -SP, Brazil

Orientador: Fábio BucaretchiDissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências MédicasResumo: Contexto: Estudos clínicos sobre acidentes com lagartas de mariposas (erucismo), incluindo acidentes com megalopigídeos, são pouco descritos no Brasil. Objetivo: Avaliar uma série de casos de erucismo admitidos na Unidade de Emergência Referenciada (UER) do Hospital de Clínicas da Unicamp e seguidos pelo Centro de Informação e Assistência Toxicológica de Campinas. Casuística e Métodos: Coorte prospectiva (janeiro de 2010 a abril de 2016). Critérios de inclusão: todos os casos de erucismo admitidos na UER. A intensidade da dor foi avaliada por escala numérica de notas de dor de 11 pontos (END 0-10). A dor foi classificada como grave na admissão na UER (T0) quando a nota atribuída foi ? 8. Resultados: No período de estudo, 278 casos de erucismo foram admitidos na UER (Podalia spp., n= 108; Megalopyge spp., n= 16; Automeris spp., n= 12; Lonomia spp., n= 3; Hylesia spp., n= 1; lagartas não trazidas para identificação ou não fotografadas, n= 138). A maioria dos acidentes ocorreu em homens (55,4%), com idade mediana de 40 anos, no verão (janeiro a março, 82,6%), na zona urbana (92,1%), e nos domicílios (61,3%). O intervalo mediano entre o acidente e a admissão na UER foi de 90 min. (IIQ: 45-150). Dor local foi a principal queixa reportada (95,3%), seguida de eritema local (82%), edema discreto (55,8%) e parestesia (21,9%). A intensidade da dor em T0 foi avaliada em 224 casos (82,7%), sendo classificada como grave em 124 casos (mediana= 8, IIQ: 6-10). Medicações para alívio da dor foram frequentemente usadas em T0, como anestesia local (40,3%) e analgésicos (76,4%), principalmente dipirona (54,7%) e opioides (14,4%). Analgesia adicional (T5 até alta da UER) foi utilizada em 80 pacientes (28,8%), em 34 casos pós-contato com megalopigídeos e, em 46 casos, com lagartas não identificadas. Em dois casos de lonomismo foi detectada coagulopatia, com um paciente sendo tratado com soro antilonômico. O tempo mediano de observação na UER foi de 75 minutos (IIQ: 45-120). Conclusões: Dor local foi a principal queixa associada com erucismo, causado, em sua maioria, por megalopigídeos do gênero Podalia. Infiltração anestésica local e analgésicos foram os procedimentos mais utilizados para controle da dor na UERAbstract: Context: Clinical studies of erucism (envenomation caused by dermal contact with larval forms of moths), including megalopigids, have been rarely described in Brazil. Objective: To evaluate a case series of erucism admitted to the Emergency Department (ED) of a public university teaching hospital and followed by the Campinas Poison Control Center. Patients and methods: Prospective cohort study (January 2010 to April 2016). Inclusion criteria: all cases of erucism admitted to our ED. A Numeric Pain Rating Scale (NPRS 0-10) was used to assess pain intensity in the ED. Pain was considered as severe upon ED admission (T0) when the NPRS was ? 8. Results: In the study period 278 cases of erucism were admitted to our ED (Podalia spp., n=108; Megalopyge spp., n=16; Automeris spp., n=12; Lonomia spp., n=3; Hylesia spp., n=1; caterpillars not brought for identification or not photographed, n=138). Most of the cases occurred in men (55.4%), with a median age of 40 years, during the summer (January to March 82.6%), in an urban setting (92.1%) and in households (61.3%). The median time between the dermal contact and admission to the ED was 90 min. (IQI: 45-150). Local pain was the main complaint reported (95.3%), followed by local erythema (82%), mild edema (55.8%) and paresthesia (21.9%). Pain intensity at T0 was assessed in 224 cases (82.7%) and was classified as severe in 124 cases (median= 8, IQI: 6-10). Medications to relief pain were frequently used at T0, such as local anesthesia (40.3%) and analgesics (76.4%), the latter involving mainly dipyrone (54.7%) and opioids (14.4%). Additional analgesia (from T5 until discharge) was required in 80 patients (28.8%), post-contact with megalopigids (n=34) and by caterpillars not brought for identification (n=46). Two cases of lonomism developed coagulopathy, with one being treated with antilonomic antivenom. The median length of the ED stay was 75 min (IQI: 45-120). Conclusion: Pain was the main complaint associated with erucism, mainly related to megalopigids of the genus Podalia. Local anesthesia and analgesics were frequently used for the management of painMestradoSaude da Criança e do AdolescenteMestra em Ciência