Fulminate Hepatic Failure in a 5 Year Old Female after Inappropriate Acetaminophen Treatment

BACKGROUND: Acetaminophen is a drug widely used in children because of its safety and efficacy. Although the risk of its toxicity is lower in children such reactions occur in pediatric patients from intentional overdoses and less frequently attributable to unintended inappropriate dosing. The aim of reporting this case is to attract the attention to the risk of the acetaminophen toxicity when administered in high doses.CASE PRESENTATION: We report here a 5 year old girl who developed fulminate liver failure with renal impairment and acute pancreatitis, as a result of acetaminophen toxicity caused from unintentional repeated supratherapeutic ingestion, with a total administered dose of 4800 mg in three consecutive days, 1600 mg/day, approximately 90 mg/kg/day. The blood level of acetaminophen after 10 hours of the last administered dose was 32 mg/l. The patient presented with high fever, jaundice, lethargic, agitating with abdominal pain accompanied by encephalopathy. The liver function test revealed with high level of alanine aminotransferase 5794 UI/l and aspartate aminotransferase 6000 UI/l. Early initiation of oral N-acetylcysteine (NAC) after biochemical evidence of liver toxicity was beneficial with rapid improvement of liver enzymes, hepatic function and encephalopathy. During the course of the illness the child developed acute pancreatitis with hyperamylasemia 255 UI/L and hyperlypasemia 514 UI/ L. Patient totally recovered within 29 days.CONCLUSION: Healthcare providers should considered probable acetaminophen toxicity in any child who has received the drug and presented with liver failure. When there is a high index of suspicion of acetaminophen toxicity NAC should be initiated and continued until there are no signs of hepatic dysfunction

Efficacy of an IgM preparation in the treatment of patients with sepsis: a double-blind randomized clinical trial in a pediatric intensive care unit

Aim: Additional treatments for sepsis to be administered alongside the standard therapy recommended by the Surviving Sepsis Campaign have recently undergone evaluation. Due to its anti-bacterial, anti-inflammatory and immunomodulatory properties, intravenous polyvalent immunoglobulin M (IgM)–enriched immunoglobulins (IgM preparation) has been investigated as one of these potentially valid adjunctive therapies. The aim of this trial was to assess the efficacy of an IgM preparation as adjuvant therapy in the treatment of pediatric patients with sepsis. Methods: In our study, 78 septic patients admitted to a pediatric intensive care unit (PICU) at the University Hospital Center “Mother Teresa” in Tirana, Albania, were randomized into two groups (intervention and control). All patients were treated according to standard PICU sepsis guidelines. Additionally, patients in the intervention group received the IgM preparation Pentaglobin® while patients in the control group received standard sepsis therapy, but no immunoglobulin  administration. Results: The survival rate was higher in the intervention group (87%, N=34) than in the control group (64%, N=25), and this difference was statistically significant  (P=0.03). Length of stay (LOS) was also significantly shorter in the intervention group. Conclusion: In this study conducted in Albania, use of an IgM preparation, in addition to standard sepsis therapy, led to a significant increase in the survival rate as well as a significant reduction in LOS compared with placebo, when administered in PICU patients with sepsis

Trends in Mortality in Children Hospitalized with Meningococcal Infections in Albania from 2006 to 2014

Background: Lack of vaccination and modern health care facilities in many countries including Albania let meningococcemia to remain as a serious challenging disorder especially among children and in spite of improved diagnosis and earlier treatment its prognosis is still dismal. Patients expected to develop life-threatening complications in acute meningococcal infections require early recognition and appropriate monitoring. Different prognostic scoring systems have been developed. Aim: The aim of this study was to evaluate mortality in children hospitalized with meningococcal infections in Albania, including scoring systems in prognosticating mortality rate. Materials and Methods: This was a retrospective descriptive study, performed on 40 patients with definite diagnosis of meningococcal infection admitted to PICU in UHC “Mother Teresa”, Tirana, Albania, between 2006 and 2014. There were 40 patients, 22(55%) males, and 18(45%) females, from 2 months to 10 years old. We evaluated all the patients based on Stiehm and Damrosch and Glasgow meningococcal septicemia prognostic score. Data were collected by filling checklists. SSPS software was applied to analyze the data using chi-square test. Results: Overall mortality was 42%. According to the GMSPS(3) prognostic score of meningococcemia: 28 (70%) patients had a score <8 points and were recorded four deaths representing a mortality rate of 14.2%; the mortality rate of 12(45%) patients with a score ≥8 points resulted in 100% mortality. The sensitivity was 100%, specificity was 100%, the positive predictive value was 100% and the negative predictive value was 100% for a GMSPS score ≥8. According to the Stiehm and Damrosch criteria (2): 22(55%) patients had two or fewer factors present and was recorded three deaths representing a mortality rate of 13.6%; the mortality rate of 18(45%) patients with three or more factors present the mortality rate was 72.2%. The sensitivity was 90%, specificity was 80%, the positive predictive value was 75% and negative predictive value was 92.3% for the criterion ≥3 of the Stiehm and Damrosch criteria. Conclusions: Meningococci are still killers, they affect men more than women. The Stiehm and Damrosch and Glasgow meningococcal septicemia prognostic score can rapidly identify children with the fulminant meningococcal disease and poor prognosis and help us starting prompt administration of suitable antibiotics, critical care, and special therapeutic measures.Keywords: Meningococcal disease, meningococcemia, meningitis, children, scoring system

Efficacy of an IgM preparation in the treatment of patients with sepsis: a double-blind randomized clinical trial in a pediatric intensive care unit

Aim: Additional treatments for sepsis to be administered alongside the standard therapy recommended by the Surviving Sepsis Campaign have recently undergone evaluation. Due to its anti-bacterial, anti-inflammatory and immunomodulatory properties, intravenous polyvalent immunoglobulin M (IgM)–enriched immunoglobulins (IgM preparation) has been investigated as one of these potentially valid adjunctive therapies. The aim of this trial was to assess the efficacy of an IgM preparation as adjuvant therapy in the treatment of pediatric patients with sepsis.Methods: In our study, 78 septic patients admitted to a pediatric intensive care unit (PICU) at the University Hospital Center “Mother Teresa” in Tirana, Albania, were randomized into two groups (intervention and control). All patients were treated according to standard PICU sepsis guidelines. Additionally, patients in the intervention group received the IgM preparation Pentaglobin® while patients in the control group received standard sepsis therapy, but no immunoglobulin  administration.Results: The survival rate was higher in the intervention group (87%, N=34) than in the control group (64%, N=25), and this difference was statistically significant  (P=0.03). Length of stay (LOS) was also significantly shorter in the intervention group.Conclusion: In this study conducted in Albania, use of an IgM preparation, in addition to standard sepsis therapy, led to a significant increase in the survival rate as well as a significant reduction in LOS compared with placebo, when administered in PICU patients with sepsis

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