Combined Hyperglycemic Hyperosmolar Syndrome and Diabetic Ketoacidosis Associated with COVID-19 in a Pediatric Patient

Although most children with coronavirus disease 2019 (COVID-19) are asymptomatic or only with mild symptoms, many symptomatic children still require admission to the intensive care unit. Multiple cases of diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic syndrome (HHS) associated with COVID-19 have been reported in adults. However, to our knowledge, only few similar cases have been published in the pediatric population. We report one of the first few severe cases of mixed HHS with DKA associated with COVID-19 in an adolescent. Our patient was successfully treated with intravenous immunoglobulin, Remdesivir, and methylprednisolone. As the pandemic continues, clinicians should be aware of this syndrome and consider early use of Remdesivir and corticosteroids. Further studies are required to understand the pathophysiology of this syndrome occurring with COVID-19.

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Dexmedetomidine-Associated Fever in a Critically Ill Obese Child

The Journal of Pediatric Pharmacology and Therapeutics ◽

10.5863/1551-6776-23.6.486 ◽

2018 ◽

Vol 23 (6) ◽

pp. 486-489

Author(s):

R. Zachary Thompson ◽

Lori McDonald ◽

Keegan Ziemba ◽

Joseph D. Tobias ◽

Claire A. Stewart

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Critically Ill ◽

Pediatric Intensive Care Unit ◽

Pediatric Patient ◽

Obese Child ◽

Pediatric Population ◽

Pediatric Intensive Care ◽

Persistent Fever ◽

Drug Fever

Dexmedetomidine use in the pediatric intensive care unit has increased in recent years. Reports of dexmedetomidine-associated drug fever have been described in adult patients; however, this has not been reported in the pediatric population. We report a case of persistent fever that resolved with the discontinuation of dexmedetomidine and successful transition to clonidine. This is the first report of dexmedetomidine drug fever in a pediatric patient.

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Mortality risk factors of a pediatric population with fulminant hepatic failure undergoing orthotopic liver transplantation in a pediatric intensive care unit*

Pediatric Critical Care Medicine ◽

10.1097/00130478-200207000-00004 ◽

2002 ◽

Vol 3 (3) ◽

pp. 227-233 ◽

Cited By ~ 24

Author(s):

Mónica A. Centeno ◽

David F. Bes ◽

Jorge S. Sasbón

Keyword(s):

Risk Factors ◽

Intensive Care Unit ◽

Liver Transplantation ◽

Intensive Care ◽

Pediatric Intensive Care Unit ◽

Fulminant Hepatic Failure ◽

Mortality Risk ◽

Hepatic Failure ◽

Pediatric Population ◽

Pediatric Intensive Care

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An Emergency Department–Based Intensive Care Unit is Associated with Decreased Hospital and Intensive Care Unit Utilization for Diabetic Ketoacidosis

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2019.10.005 ◽

2020 ◽

Vol 58 (4) ◽

pp. 620-626 ◽

Cited By ~ 4

Author(s):

Nathan L. Haas ◽

Sage P. Whitmore ◽

James A. Cranford ◽

Ryan E. Tsuchida ◽

Adam Nicholson ◽

...

Keyword(s):

Intensive Care Unit ◽

Emergency Department ◽

Intensive Care ◽

Diabetic Ketoacidosis

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2 Systemic glucocorticoids and bradycardia in critically ill children: a retrospective study

Paediatrics & Child Health ◽

10.1093/pch/pxaa068.001 ◽

2020 ◽

Vol 25 (Supplement_2) ◽

pp. e1-e1

Author(s):

Camille Maltais-Bilodeau ◽

Maryse Frenette ◽

Geneviève Morissette ◽

Dennis Bailey ◽

Karine Cloutier ◽

...

Keyword(s):

Intensive Care Unit ◽

Heart Rate ◽

Intensive Care ◽

Retrospective Study ◽

Critically Ill ◽

Medical Staff ◽

Pediatric Population ◽

Critically Ill Children ◽

Rate Variation ◽

The Impact

Abstract Background Glucocorticoids are widely used in the pediatric population. They are associated with numerous side effects including repercussions on the cardiovascular system. The impact on heart rate is not well known, but bradycardia has been reported, mostly with high doses. Objectives We described the occurrence of bradycardias and the variation of heart rate in critically ill children receiving glucocorticoids. Design/Methods We conducted a retrospective study including 1 month old to 18 year old children admitted to the Pediatric Intensive Care Unit between 2014 and 2017, who received a glucocorticoid dose equivalent to 1 to 15 mg/kg/day of prednisone. We collected data on exposition to glucocorticoids, heart rate before, during and after the exposition, and interventions from the medical staff in response to bradycardia. The primary outcome was the occurrence of bradycardia and the secondary outcomes were the magnitude of heart rate variation and the clinical management of bradycardias. Results We included 92 admissions (85 patients). The median dose of glucocorticoid used was 2.80 mg/kg/day of prednisone (2.08—3.80). We found 70 cases (76%) with at least one bradycardia. Before treatment, all patients had a mean heart rate higher than the 5th percentile for age. During exposition to glucocorticoids, 8 patients (10%, n = 83) had a median heart rate ≤ 5th percentile. We noted 46 cases of bradycardia (50%) that led to an intervention from the medical staff, but no patient had a major event associated to bradycardia. We found a significant association between bradycardia and age (estimate -0.136, 95% CI -0.207—-0.065, p < 0.001), glucocorticoid dose (estimate 4.820, 95% CI 2.048—7.592, p < 0.001) and intravenous administration (estimate 8.709, 95% CI 1.893—15.524, p = 0.012). Conclusion In our study, most children hospitalized at the intensive care unit receiving standard doses of glucocorticoid experienced bradycardia. The majority of episodes led to an intervention from the medical staff. Presence of bradycardia was associated with younger age, higher dose and IV administration of glucocorticoids.

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Comparison of ICU Outcomes between Intravenous Immunoglobulin and Plasma Exchange in Treatment of Mechanically Ventilated Patients with GuillainBarré Syndrome in a Neuro-Intensive Care Unit in a Govt. Hospital of Bangladesh: A Observational Cohort Study

Journal of National Institute of Neurosciences Bangladesh ◽

10.3329/jninb.v5i2.43015 ◽

2019 ◽

Vol 5 (2) ◽

pp. 118-122

Author(s):

Uzzwal Kumar Mallick ◽

Mohammad Shah Jahirul Hoque Chowdhury ◽

Mohammad Enayet Hussain ◽

Mohammad Asaduzzaman ◽

Md Sirajul Islam ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Intravenous Immunoglobulin ◽

Statistical Significance ◽

Axonal Neuropathy ◽

Male Predominance ◽

Icu Stay ◽

The Mean ◽

Group 2 ◽

Group 1

Background: The management of Guillain-Barré Syndrome is very crucial for the outcome of the patient. Objective: The aim of the study was to compare efficacy of IvIg(Intravenous Immunoglobulin) versus PE(Plasmaexchange) in treatment of mechanically ventilation adults with GBS in neuro-intensive care unit of Bangladesh. Methodology: Thiswas a prospective, observationalcohort study, in a Neuro-ICU from 2017 to 2018. We included all patients with GBS who required mechanical ventilation (MV). We defined two groups: group 1 (group treated by IvIg: 0.4 g/kg/day for 5 days) and group 2 (group treated by PE: 5 PE during 10days, every alternate day). We collectedclinical and therapeutic aspects and outcome. Results: A total number of 49 patients (34 in group 1 and 15 in group 2) were enrolled. The mean age was 37.4±9.2 years, with a male predominance (65.3%). on electrophysiological findings, in 4(32.7%) patients had acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and acute motor axonal neuropathy (AMAN) in 26 (53.1%) patients and acute motor-sensory axonal neuropathy (AMSAN) was 3(6.1%)and NCS was not done in 4(8.2%) cases. The mean length of ICU stay was 20±19.10 days and 46.60±30.02 days in IVIG and PE group respectively. The ICU stay was significantly shorter (p = 0.001) in the IvIg group than PE group. Patients receiving IvIg were early weaned of MV (p = 0.002) compared to those receiving PE with a statistical significance. Also, duration of M/V (P=.002), Need of tracheostomy (p=.005) and over all surval rate (p=.007) was significantly in favoue of IvIg group than PE group. Out of 49 patients, total 3 patients were died and they all were AMAN variety. Conclusion: Our work reveals a meaningful difference for the MV duration, ICU stay, weaning and excellent recovery in IvIg group compared to PE group in terms of less complcations. Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 118-122

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Effect of Potassium Infusions on Serum Levels in Children during Treatment of Diabetic Ketoacidosis

Journal of Pediatric Intensive Care ◽

10.1055/s-0039-1700981 ◽

2020 ◽

Vol 09 (02) ◽

pp. 113-118 ◽

Cited By ~ 1

Author(s):

Sangita Basnet ◽

Rawan Musaitif ◽

Aayush Khanal ◽

Kimberly Powell ◽

Giovanna Caprirolo ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Retrospective Study ◽

Diabetic Ketoacidosis ◽

Treatment Period ◽

Pediatric Intensive Care ◽

Serum Levels ◽

K Value ◽

Data Points ◽

Low K

AbstractA retrospective study was done to determine the effect of potassium (K+) infusions on serum levels in children admitted to the pediatric intensive care unit (PICU) with diabetic ketoacidosis (DKA). Eighty-two percent of 92 cases studied received 40 mEq/L K+ infusion over the treatment period of median 13.0 (interquartile range [IQR]: 7–18) hours. The median K+ value at the end of this period was 3.9 (IQR: 3.4–4.2) mEq/L. There were 31 data points of low K+ values (<3.5 mEq/L) and 4 high values (>5.5 mEq/L) during this treatment period. The K+ infusions of 40 mEq/L may be sufficient to normalize serum K+ when treating DKA.

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