Severe anemia of unexpected cause in a female teenager

University of Medicine and Pharmacy, Iasi, Romania, The 6th International Medical Congress for Students and Young Doctors, May 12-14, 2016Introduction: In pediatric practice topiramate is used alone or with other medicines to treat certain types of seizures and to prevent migraine headaches in adolescents 12 years and older. Clinical case: A14 years-old female was admitted into the ER Unit after voluntary ingestion of 30 capsules (3000 mg) of topiramate. The drug was prescribed by her neurologist for migraines; the suicidal attempt was determined by a conflict with her mother. At admission she had dizziness, drowsiness, speech disturbances,abnormal coordination, vomiting and abdominal pain. Laboratory data showed severe anemia (Hb=4,3 g/dl), normochrome and normocytic, severe metabolic acidosis(HCO3 - = 6,6 mEq/L), hypoglycemia (37 mg/dl), hypercloremia(Cl-=121,7 mEq/L), hypernatremia (Na+= 150 mEq/L),hypokalemia (K+ =1,71 mEq/L). The treatment included gastric lavage, activated charcoal, intravenous fluids, bicarbonate and blood transfusions. The clinical status improved within 24 hours, Hb level raise to 13,8 g/dl and no other laboratory abnormalities were found. The medical records of the patient showed she has no anemia previously. A CT scan performed in order to exclude an organic cause for her headaches was normal. The patient was dismissed after 10 days in good general condition; she presented mild epigastric pain and leave the hospital with proton-pump inhibitor and pshychologic counceling recommendations. Subsequently she had several hospitalisations for depression and suicidary thoughts treated with sertraline and she is followed by a pediatric psychiatrist. Conclusions: This is a particular case of voluntary topiramate intoxication with particular side effects as severe anemia and metabolic disturbances, followed by long-term behavioral consequences

An international multidisciplinary consensus on pediatric metabolic dysfunction-associated fatty liver disease

Background: Non-alcoholic fatty liver disease (NAFLD) is highly prevalent in children and adolescents, particularly those with obesity. NAFLD is considered a hepatic manifestation of the metabolic syndrome due to its close associations with abdominal obesity, insulin resistance, and atherogenic dyslipidemia. Experts have proposed an alternative terminology, metabolic dysfunction-associated fatty liver disease (MAFLD), to better reflect its pathophysiology. This study aimed to develop consensus statements and recommendations for pediatric MAFLD through collaboration among international experts. Methods: A group of 65 experts from 35 countries and six continents, including pediatricians, hepatologists, and endocrinologists, participated in a consensus development process. The process encompassed various aspects of pediatric MAFLD, including epidemiology, mechanisms, screening, and management. Findings: In round 1, we received 65 surveys from 35 countries and analyzed these results, which informed us that 73.3% of respondents agreed with 20 draft statements while 23.8% agreed somewhat. The mean percentage of agreement or somewhat agreement increased to 80.85% and 15.75%, respectively, in round 2. The final statements covered a wide range of topics related to epidemiology, pathophysiology, and strategies for screening and managing pediatric MAFLD. Conclusions: The consensus statements and recommendations developed by an international expert panel serve to optimize clinical outcomes and improve the quality of life for children and adolescents with MAFLD. These findings emphasize the need for standardized approaches in diagnosing and treating pediatric MAFLD. Funding: This work was funded by the National Natural Science Foundation of China (82070588, 82370577), the National Key R&D Program of China (2023YFA1800801), National High Level Hospital Clinical Research Funding (2022-PUMCH-C-014), the Wuxi Taihu Talent Plan (DJTD202106), and the Medical Key Discipline Program of Wuxi Health Commission (ZDXK2021007)