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

The Importance of Bedside Ultrasonography in Confirming the Location of Endotracheal Tube

Objective. Endotracheal intubation may be associated with lethal complications when not applied in appropriate manner. In this study, we aimed to examine the efficiency of transcricoid and pulmonary ultrasonography in confirming the position of the tube in comparison with classical methods. Methods. This study was carried out between 2016 and 2017 in Turkey and was registered in Clinical Trials under number NCT03081221. The location of the tube was confirmed using methods such as monitoring the vocal cords during direct laryngoscopy, condensation on endotracheal tube during respiration, epigastric-pulmonary auscultation, radiography and capnometry. After that, the transcricoid and pulmonary ultrasonography were implemented by the blinded pediatric emergency care specialist. Results. 64 cases who needed advanced airway requirements were involved in this study. The double-line appearance could not be obtained from one patient only when using transcricoid ultrasonography, but the bilateral pleural shift movement was observed among all the cases by using pulmonary ultrasonography (sensitive: 98%-100%). Conclusion. The determination of endoesophageal, endotracheal and endobronchial intubations can be easily made by using transcricoid and pulmonary ultrasonography. The use of ultrasonography may significantly contribute to critical airway management as fast, accurate and on time

Ecballium Elaterium Poisoning in Pediatric Emergency Service: A Case Report

WOS: 000428746600021Background Ecballium elaterium is the only species belonging to the genus Ecballium of Cucurbitaceae family. It is native to the Mediterranean region. Despite its side effects, E. elaterium has still been being used as an alternative treatment agent for sinusitis, cirrhosis, rheumatic diseases and hemorrhoids for its anti-inflammatory and cathartic actions. Herein we discuss a pediatric case showing gastrointestinal side effects after ingesting E. elaterium. Case Report: A six-year-old boy admitted to Cukurova University Medical Faculty Pediatric Emergency Department, Turkey, for vomiting one hour after ingesting a green plant which he had tasted to satisfy his curiosity. Physical examination, vital signs and laboratory tests revealed normal. The ingested plant was defined to be E. elaterium. Maintenance fluid infusion, 1 mg/kg ranitidine and sucralfate medications were commenced. During the follow-up, the patient developed numbness of the tongue and hyper-salivation, without any signs of uvular edema or other system findings. Further follow-up showed stable vital signs within the normal range with no additional complications. The patient was sent home with the cure and recommendations. Discussion: The plants and herbs that are used as agents of alternative or complementary medicine may as well be accidentally or curiously taken by children leading to unwanted intoxication cases. Pre-encounter actions to prevent such cases are as important as any post-exposure clinical interventions to impede the unwanted consequences. One such measure might be a more intensive public information policy underscoring the fact that plants have the potential to be noxious and may cause serious side effects and even death

EVALUATION OF CHILDHOOD POISONINGS IN CUKUROVA REGION

WOS: 000269311600008Objective: The aim of this study was to clarify to determine the causes of childhood poisonings by time on account of socioeconomic and cultural alterations in Cukurova region and to steadily attain the data for treatment and prevention. Matetial and Method: This study was composed of poisoning cases attending to pediatric emergency medicine room from 1997 to 2001 with ages between 0-14 years old. The data about poisoning cases were extracted from patients' medical records in emergency room. In the study demographics of cases, the route and reason of poisonings and materials causing poisonings were evaluated. Results: In 5 years period totally 486 patients, 250 boys and 236 girls, were admitted to pediatric emergency room. Most of the poisoning cases were due to air accident (89.3%), and they were between 1-3 years old. Suicide attempts had the highest ratio in cases over 10 years age, and were more common in girls. The causes of poisoning were found to be drugs (42.6%), animal-insect bites insectisides-farming disinfectants (10.3%) and costic substances (8.6%). Most cases with drug poisonings were caused by CNS drugs, especially amitriptiline (32.8%). In all poisoning cases, 99.6% of cases have recovered completely but two cases (snake and scorpion envenomation) died (0.4%). Conclusion: The majority of poisonings in the childhood period happen due toaccidental ingestion of drugs. This condition shows us that simple precautions like family education, keeping drugs unreachable for children, unavailability of drugs without prescription and child-resistant package may prevent most of the poisonings

Isoniazid Intoxication: Three Case Reports

WOS: 000287686200022Tuberculosis is still an important health problem in our country as its prevalence has increased in recent years. Isoniazid is one of the most commonly used antituberculous drugs because it is cheap and efficacious. When administered at high doses; it can cause convulsions, metabolic acidosis, lactic acidosis, rhabdomyolisis, coma, and even death. The basis of therapy consists of parenteral pyridoxine administration in a dose equivalent to that of the ingested isoniazid. Here we reported three cases of acute isoniazid intoxication presenting with convulsions and aimed to discuss the clinical signs, pathophysiology, and treatment of isoniazid intoxication

The role of plasmapheresis in organophosphate poisoning: Case reports of three pediatric patients

The aim of the study was to assess the impact of plasmapheresis treatment in the management of three pediatric patients with organophosphate poisoning who did not respond to standard treatment. The treatment of signs and symptoms, and supportive treatment has been evaluated in this paper

The role of plasmapheresis in organophosphate poisoning: case reports of three pediatric patients

The aim of the study was to assess the impact of plasmapheresis treatment in the management of three pediatric patients with organophosphate poisoning who did not respond to standard treatment. The treatment of signs and symptoms, and supportive treatment has been evaluated in this paper

The Effect of Ketamine Administration on Pain Control in Painful Crisis of Sickle Cell Anemia Patients during Childhood: A Retrospective Observational Study

60th Annual Meeting of the American-Society-of-Hematology (ASH) -- DEC 01-04, 2018 -- San Diego, CAWOS: 000454842805196…Amer Soc Hemato

Intravenous Paracetamol Overdose A Pediatric Case Report

WOS: 000458555400009PubMed ID: 29489610Paracetamol is a common antipyretic often used to treat children with fever and pain. With the increasing administration of intravenous (IV) paracetamol, there will be the associated risk of medication dosing errors. We report a case of IV paracetamol overdose in a child with fever during hospital admission. A IV paracetamol dosing error occurred, with delayed recognition resulting in transient hepatotoxicity, with a peak alanine transaminase of 1946 IU/L and aspartate transaminase of 1633 IU/L