Urtikarija kao rijetka nuspojava polietilen glikola-3350 kod djeteta: prikaz slučaja

Polyethylene glycol electrolyte (PEG-3350) solution is usually used for bowel emptying before co-lonoscopy in adults. It has also been reported to be safe in children. It is thought that bowel irrigation with this solution can be a useful treatment alternative for poisoning with slow releasing drugs, swallowed packaged substances, enteric coated drugs, drugs not binding to charcoal, and heavy metals in children. Due to high molecular weight of PEG-3350, its absorption from the intestinal mucosa is very low (0.2%). Therefore, it is less likely to have side effects. A three-year-old girl bit and ate one-third of an alkali battery and was brought to our pediatric emergency unit. Vital signs and results of physical examination and laboratory investigations were normal. Irrigation of the bowels with PEG-3350 solution given orally at a rate of 20 mL/kg/h was initiated. Upon excretion of feces of normal appearance in the sixth hour, irrigation was continued. Since rashes and itching started throughout her body in the thirtieth hour after administration of 9 L PEG-3350, the irrigation was discontinued and the patient was administered antihistamines. Rashes and itching regressed within one hour of its discontinuation. This suggested that they were due to the irrigation solution. There are five adult cases of allergic reactions to PEG-3350 reported in the literature. The case presented is the first pediatric patient developing allergic reaction to PEG-3350.Otopina polietilen glikola (PEG-3350) najčešće se primjenjuje za pražnjenje crijeva prije kolonoskopije u odraslih osoba, a opisuje se kao sigurno sredstvo i u djece. Smatra se da ispiranje crijeva ovom otopinom može biti korisna alternativa za liječenje otrovanja lijekovima sa sporim otpuštanjem, progutanim pakovanjima nekih tvari, lijekovima sa zaštitnom ovojnicom za probavni sustav, lijekovima koji se ne vežu na ugljen te teškim metalima u djece. Zbog velike molekularne težine vrlo mali dio PEG-3350 (0,2%) se apsorbira iz crijevne sluznice pa su stoga nuspojave manje vjerojatne. Djevojčica u dobi od tri godine zagrizla je i progutala jednu trećinu alkalne baterije pa je dovedena u našu hitnu pedijatrijsku službu. Vitalni znaci kao i rezultati fizikalnog pregleda i laboratorijskih pretraga bili su normalni. Započeto je ispiranje crijeva otopinom PEG-3350 peroralno, 20 mL/kg/h. Nakon što je dijete imalo stolicu normalnog izgleda u šestom satu, ispiranje je nastavljeno. Međutim, nakon što je djevojčica primila 9 L PEG-3350, u tridesetom satu davanja otopine nastupio je osip i svrbež po čitavom tijelu pa je ispiranje crijeva prekinuto i djetetu su dani antihistaminici. Osip i svrbež su se povukli unutar jednog sata od prestanka ispiranja otopinom PEG-3350. U literaturi je opisano pet slučajeva alergijskih reakcija na PEG-3350 u odraslih osoba. Ovaj prikaz opisuje prvi slučaj alergijske reakcije na PEG-3350 u djeteta

Evaluation of nutritional status in pediatric intensive care unit patients: The results of a multicenter, prospective study in Turkey

IntroductionMalnutrition is defined as a pathological condition arising from deficient or imbalanced intake of nutritional elements. Factors such as increasing metabolic demands during the disease course in the hospitalized patients and inadequate calorie intake increase the risk of malnutrition. The aim of the present study is to evaluate nutritional status of patients admitted to pediatric intensive care units (PICU) in Turkey, examine the effect of nutrition on the treatment process and draw attention to the need for regulating nutritional support of patients while continuing existing therapies.Material and MethodIn this prospective multicenter study, the data was collected over a period of one month from PICUs participating in the PICU Nutrition Study Group in Turkey. Anthropometric data of the patients, calorie intake, 90-day mortality, need for mechanical ventilation, length of hospital stay and length of stay in intensive care unit were recorded and the relationship between these parameters was examined.ResultsOf the 614 patients included in the study, malnutrition was detected in 45.4% of the patients. Enteral feeding was initiated in 40.6% (n = 249) of the patients at day one upon admission to the intensive care unit. In the first 48 h, 86.82% (n = 533) of the patients achieved the target calorie intake, and 81.65% (n = 307) of the 376 patients remaining in the intensive care unit achieved the target calorie intake at the end of one week. The risk of mortality decreased with increasing upper mid-arm circumference and triceps skin fold thickness Z-score (OR = 0.871/0.894; p = 0.027/0.024). The risk of mortality was 2.723 times higher in patients who did not achieve the target calorie intake at first 48 h (p = 0.006) and the risk was 3.829 times higher in patients who did not achieve the target calorie intake at the end of one week (p = 0.001). The risk of mortality decreased with increasing triceps skin fold thickness Z-score (OR = 0.894; p = 0.024).ConclusionTimely and appropriate nutritional support in critically ill patients favorably affects the clinical course. The results of the present study suggest that mortality rate is higher in patients who fail to achieve the target calorie intake at first 48 h and day seven of admission to the intensive care unit. The risk of mortality decreases with increasing triceps skin fold thickness Z-score

Cyanide intoxication by apricot kernels: A case report and literature review

WOS: 000482761300009Acute cyanide intoxication is a serious healthcare problem due to its potentially life threatening and fatal toxic effects. Ingestion of cyanide containing foods is an important source of cyanide poisoning and apricot kernels contain significant amounts of such cyanogenic compounds. Herein we report a previously healthy 4-year-old boy admitted to our emergency department with complaints of vomiting and sudden onset of unconsciousness after ingestion of apricot kernels. He was diagnosed as acute cyanide poisoning and treated with a specific antidote; hydroxocobalamin. Our report concludes with previous cases of cyanide poisoning after ingestion of apricot kernels and a quick look at sources, manifestations and treatment of acute cyanide poisoning

Assessment of neurologic patients who treated therapeutic plasmapheresis at pediatric intensive care unit: 10 years experience

AMAÇ: Çocuk yoğun bakım ünitemizde plazmaferez ile tedavi edilen nörolojik hastalıkları, endikasyonları plazmaferez tekniği ve komplikasyonlar açısından değerlendirmek; medikal tedaviye dirençli veya hızlı ilerleyen nörolojik hastalıklarda plasmaferez tedavisinin önemini vurgulamak amaçlanmıştır. YÖNTEM ve GEREÇLER: Çukurova Üniversitesi Tıp Fakültesi Balcalı Hastanesi Çocuk Yoğun Bakım Ünitesi'nde, Temmuz 2005 ve Nisan 2015 tarihleri arasında nörolojik hastalıklar nedeniyle terapötik plazmaferez uygulanmış olan 41 hastanın verileri retrospektif olarak gözden geçirildi. BULGULAR: Nörolojik hastalıklar arasında en sık endikasyon %46,3 oranında Guillain Barre Sendromu iken diğer endikasyonlar %24,4 otoimmun ensefalit, %12,2 akut demyelinizan ensefalomyelit, %9,8 myastenia gravis ve %7,3 refrakter status epileptikus olarak bulundu. Replaman sıvısı olarak %83 albümin+taze donmuş plazma, %14,6 albümin ve %2,4 taze donmuş plazma kullanıldı. İşlemler sırasında antikoagulan olarak ACD-A kullanıldı ve kalsiyum glukonat rutin uygulandı. Komplikasyon olarak en sık %29,2 oranında hipotansiyon gözlendi. Diğer komplikasyonlar %9,7 ürtiker, ateş gibi alerjik reaksiyonlar ve %4,8 hipertansiyon idi. Hastaların hiçbiri plazmaferez işlemine bağlı olarak hayatını kaybetmedi. TARTIŞMA ve SONUÇ: Terapötik plazmaferez medikal tedaviye yanıt vermeyen veya hızlı ilerleyen Guillain Barre Sendromu, akut demyelinizan ensefalomyelit ve myastenia gravis'de ilk basamak tedavi olarak düşünülmelidir. Otoimmun ensefalit ve refrakter status epileptikus tedavisinde plazmaferezin yeri konusunda daha kesin verilere ihtiyaç duyulmaktadır.INTRODUCTION: The aim of this study was to report our experience with therapeutic plasmapheresis for neurological diseases in regard to the indications, technique and complications in our pediatric intensive care unit. We aimed to emphasize the role of plasmapheresis in treatment resistant and progressive neurological diseases METHODS: We performed retrospective medical record analysis of 41 patients who were treated with plasmapheresis for neurological disorders between July 2005 and April 2015 at Çukurova University Balcalı Hospital Pediatric Intensive Care Unit. RESULTS: The most common indication for therapeutic plasmapheresis was Guillain Barre Syndrome (46.3% ) followed by autoimmune encephalitis (24.4%), acute disseminated encephalomyelitis (12.2%), myasthenia gravis (9.8%) and refractory status epilepticus (7.3%). For the replacement albumin+fresh frozen plasma mixture (83%), albumin alone (4,6%) and fresh frozen plasma alone(2,4%) were used. During procedures ACD-A was used for anticoagulation, and calcium gluconate was infused routinely. The most frequent complication was hypotension(29.2%).The remainder were allergic reactions like fever andurticaria(9.7%) and hypertension (4.8%). There was no death related to plasmapheresis. DISCUSSION AND CONCLUSION: Therapeutic plasmapheresis is the first line treatment for neurological diseases which progress rapidly and are unresponsive to conventional treatments like Guillain Barre Syndrome, acute disseminated encephalomyelitis and myasthenia gravis. There is more to learn about the role of plasmapheresis treatment for autoimmune encephalitis and refractory status epilepticus