Severe lupin bean intoxication: an anticholinergic toxidrome

Lupin beans are the yellow legume seeds of the genus Lupinus. They are traditionally eaten as a pickled snack in many countries. Bitter lupin beans have a high amount of alkaloids called lupanine. Because the alkaloid is responsible for anticholinergic toxidrome, the beans should pass a debittering process before consumption. Only few pediatric cases of lupin bean intoxication were reported. We present a 12-year-old boy who visited the emergency department for the unexpected onset of anticholinergic toxidrome

Severe influenza virus infection in children admitted to the PICU: Comparison of influenza A and influenza B virus infection

Although the influenza virus usually causes a self-limiting disease, deaths are reported even in children without risk factors. We aimed to identify the clinical features, mortality associated with severe influenza A and B virus infections of children admitted to the pediatric intensive care unit (PICU). We conducted a retrospective study of children with confirmed influenza infection between 2012 and 2019 who were admitted to the PICU. Demographic features, risk factors, clinical data, microbiological data, complications, and outcomes were collected. Over seven influenza seasons (2012-2011 to 2015-2016), 713 children diagnosed with laboratory-confirmed influenza-related LRTI, and PICU admission was needed in 6% (46/713) of the patients. Thirty-one patients (67.4%) were diagnosed with influenza A and 15 patients were diagnosed with influenza B. Epidemiologic and clinical characteristics were similar in both influenza types, lactate dehydrogenase levels were significantly higher for influenza A than for influenza B infections. Although the influenza A to B ratio among the patients admitted to the PICU was 2.06, the percentage of cases requiring PICU admission was nearly two times higher in influenza B cases. There was no statistically significant difference in disease severity and complications in patients with influenza A and influenza B

First Successful Organ Procurement From a Pediatric Patient With a Nonpulsatile Ventricular Assist Device

Left ventricular assist devices have become an important therapeutic option as a mechanical circulatory support system in the treatment of end -stage heart failure. Organ transplants from brain dead donors on mechanical circulatory support are rare. In the literature, many successful solid-organ transplants have been reported using these donors. However, to our knowledge, this is the first report of successful solid-organ transplant from a child donor with a nonpulsatile ventricular assist device

Sepsis associated acute kidney injury in pediatric intensive care unit

Background We aimed to compare the acute kidney injury (AKI) incidence in pediatric septic shock patients according to the three different classifications. Methods We analyzed retrospectively 52 patients with severe sepsis between January 2019 and December 2019. Results While 21 patients have been diagnosed with SA-AKI according to the pRIFLE criteria, 20 children have been diagnosed according to the AKIN criteria, and 21 children have been diagnosed according to the KDIGO criteria. Older age, lower platelet count were determined as independently risk factor for SA-AKI. Older age and higher PRISM score were associated with mortality. According to Canonical correlation coefficients, pRIFLE is the most successful classification to distinguish AKI state. The canonical correlation coefficients for pRIFLE, KDIGO, and AKIN were 0.817, 0.648, and 0.615, respectively. Conclusion Although AKI incidence was similar between the three classifications, pRIFLE was the most successful classification to distinguish AKI state

Continuous EEG Monitoring in Critically Ill Children and Prognostic Factors for Short-term Outcome: An Observational Study

Aim: To evaluate the association of etiology, continuous electroencephalography (cEEG) findings and neuroimaging findings with short-term outcomes for patients admitted to a pediatric intensive care unit (PICU) for acute encephalopathy. Materials and Methods: A total of 24 children admitted to a PICU for acute encephalopathy were enrolled into this study. The etiology, treatment, duration of stay in the PICU, their demographic information and their past medical history were recorded. cEEG was initiated as quickly as possible following admission to the PICU and continued for at least 24 hours. Their short-term prognosis was evaluated by the Pediatric Cerebral Performance Category score (PCPC) at PICU discharge. Results: The most common cause was traumatic brain injury comprising 25% (n=6) of all cases. Other common causes were asphyxia (hanging, foreign body aspiration, drowning) (n=4, 16.67%) and intoxication (n=3, 12.5%). Twenty-two patients underwent cranial imaging. The most common findings in CT were hemorrhage (n=6, 30%) and ischemia/edema (n=6, 30%). Fourteen patients had unfavorable PCPC outcome scores. There was a tendency for poorer outcomes in those patients with hemorrhage/fracture or ischemia/edema in the imaging and for those patients who needed either pre-hospital CPR or had non-convulsive seizures but without statistical significance. Conclusion: cEEG in critically ill children is useful for detecting both epileptic and non-epileptic events. The use of cEEG in PICUs can be helpful for the better management of cases

Hyponatremia in Children with Acute Lymphoblastic Leukemia

Yazici Ozkaya, Pinar/0000-0002-1209-2534; Ozen, Selime/0000-0002-7156-7480WOS: 000533660200011Aim: Hyponatremia is a common electrolyte abnormality in hospitalized patients. Administration of isotonic maintenance fluids is recommended to prevent hyponatremia. the present study was conducted to evaluate the frequency and severity of hyponatremia in children with acute lymphoblastic leukemia (ALL). Materials and Methods: the frequency, severity and possible causes of hyponatremia in children with ALL throughout their entire intensive treatment were retrospectively evaluated. All children in this study received isotonic fluids as maintenance IV treatment during the hospitalization period. Results: in a five-year period, 618 hyponatremia episodes seen in 92 children with ALL (median age 59 months), treated with ALLIC 2002 protocol were entered into the study. the median number of hyponatremia episodes per patient was 6. All patients had at least one hyponatremia episode of which 83.2% were classified as mild, 13.2% as moderate, 2.9% as severe and 0.6% as very severe. the median duration of hyponatremia episodes was 5 (range between 1-43) days. the total duration of all hyponatremia episodes of each patient varied from 6 to 138 days with a median of 30 days. in 241 episodes of 68 children, there was inadequate salt intake secondary to oral feeding intolerance, nausea, vomiting and oral aphthous stomatitis. in four patients, seizure was seen during the hyponatremia period and thought to be secondary to hyponatremic encephalopathy. No patient developed central pontine myelinolysis. Conclusion: Hyponatremia is very frequent in ALL patients. Despite the use of isotonic IV fluids, it seems it cannot be completely prevented