Severe hospital-acquired hyponatremia in acutely ill children receiving moderately hypotonic fluids

Background Hypotonic fluids have been associated with hospital-acquired hyponatremia. The incidence of life-threatening severe hyponatremia associated with hypotonic fluids has not been evaluated. Methods This was a population-based cohort study of 46,518 acutely ill children 15 years of age or under who visited the pediatric emergency department (ED) at Oulu University Hospital, Finland, between 2007 and 2017. We retrieved all electrolyte measurements from the comprehensive electronic laboratory system and reviewed medical records for all patients with severe hyponatremia. Results The overall occurrence of severe hyponatremia (serum sodium < 125 mmol/L) was found in 27 out of 46,518 acutely ill children (0.06%, 95% confidence interval 0.04-0.08%). After admission, severe hyponatremia developed in seven of 6,984 children receiving moderately hypotonic fluid therapy (0.1%, 95% confidence interval 0.04-0.2%), usually within 8 h of admission. All children who developed severe hyponatremia during hospitalization were severely ill. Conclusion In this register-based cohort study of children presenting to the ED, severe hyponatremia developed in one of 998 acutely ill children receiving moderately hypotonic fluid therapy.Peer reviewe

Severe hospital-acquired hyponatremia in acutely ill children receiving moderately hypotonic fluids

Background Hypotonic fluids have been associated with hospital-acquired hyponatremia. The incidence of life-threatening severe hyponatremia associated with hypotonic fluids has not been evaluated. Methods This was a population-based cohort study of 46,518 acutely ill children 15 years of age or under who visited the pediatric emergency department (ED) at Oulu University Hospital, Finland, between 2007 and 2017. We retrieved all electrolyte measurements from the comprehensive electronic laboratory system and reviewed medical records for all patients with severe hyponatremia. Results The overall occurrence of severe hyponatremia (serum sodium < 125 mmol/L) was found in 27 out of 46,518 acutely ill children (0.06%, 95% confidence interval 0.04-0.08%). After admission, severe hyponatremia developed in seven of 6,984 children receiving moderately hypotonic fluid therapy (0.1%, 95% confidence interval 0.04-0.2%), usually within 8 h of admission. All children who developed severe hyponatremia during hospitalization were severely ill. Conclusion In this register-based cohort study of children presenting to the ED, severe hyponatremia developed in one of 998 acutely ill children receiving moderately hypotonic fluid therapy.Peer reviewe

Perinnöllinen hemofagosyyttinen oireyhtymä:harvinainen imeväisen kuumeen syy

Tiivistelmä Hemofagosyyttinen lymfohistiosytoosi (HLH) on henkeä uhkaava tulehdusreaktio, jonka syntymekanismina on T-imusolujen ja makrofagien keskinäinen sytokiinivälitteinen aktivaatio. Taudin tunnusmerkkejä ovat epäselvä ja pitkittynyt kuume, maksan ja pernan suurentuminen sekä verenkuvan solupuutokset. Perinnöllinen HLH (FHL) on ryhmä geneettisiä sairauksia, joissa tauti kehittyy ensimmäisten elinkuukausien aikana muutoin terveelle lapselle. FHL johtuu sytotoksisten imusolujen kyvyttömyydestä tuhota tulehdusvasteen herättäneet antigeeniä esittelevät solut, mistä seuraa sytokiinivälitteinen itseään voimistava tulehdusreaktio. FHL:n hoito perustuu T-solujen tukahduttamiseen ja allogeeniseen kantasolusiirtoon. FHL on harvinainen mutta merkittävä erotusdiagnostinen vaihtoehto, kun kuumeisen imeväisen verenkuvassa havaitaan solupuutoksia. Taudin nopea tunnistaminen on tärkeää, jotta tehokas hoito päästään aloittamaan ennen monielinvauriota

Functional Genetic Targeting of Embryonic Kidney Progenitor Cells Ex Vivo

The embryonic mammalian metanephric mesenchyme (MM) is a unique tissue because it is competent to generate the nephrons in response to Wnt signaling. An ex vivo culture in which the MM is separated from the ureteric bud (UB), the natural inducer, can be used as a classic tubule induction model for studying nephrogenesis. However, technological restrictions currently prevent using this model to study the molecular genetic details before or during tubule induction. Using nephron segment-specific markers, we now show that tubule induction in the MM ex vivo also leads to the assembly of highly segmented nephrons. This induction capacity was reconstituted when MM tissue was dissociated into a cell suspension and then reaggregated (drMM) in the presence of human recombinant bone morphogenetic protein 7/human recombinant fibroblast growth factor 2 for 24 hours before induction. Growth factor-treated drMM also recovered the capacity for organogenesis when recombined with the UB. Cell tracking and time-lapse imaging of chimeric drMM cultures indicated that the nephron is not derived from a single progenitor cell. Furthermore, viral vector-mediated transduction of green fluorescent protein was much more efficient in dissociated MM cells than in intact mesenchyme, and the nephrogenic competence of transduced drMM progenitor cells was preserved. Moreover, drMM cells transduced with viral vectors mediating Lhx1 knockdown were excluded from the nephric tubules, whereas cells transduced with control vectors were incorporated. In summary, these techniques allow reproducible cellular and molecular examinations of the mechanisms behind nephrogenesis and kidney organogenesis in an ex vivo organ culture/organoid setting