scholarly journals Liver, Renal, and Cardiovascular Failure After Unintentional Overdose of Tizanidine in a 2-Year-Old Child

2021 ◽  
Vol 26 (6) ◽  
pp. 643-646
Author(s):  
Jorgina Vila ◽  
Andrés Morgenstern ◽  
Lourdes Vendrell ◽  
Juan Ortega ◽  
Imma Danés
Keyword(s):  
Nasogastric Tube ◽  
Muscle Tone ◽  
Pediatric Population ◽  
Clinical Status ◽  
Pediatric Intensive Care ◽  
Intensive Care Unit Treatment ◽  
Impaired Liver Function ◽  
Oral Nutrition ◽  
Cardiovascular Failure ◽  
Spastic Quadriplegia

Tizanidine is a central alpha-2 adrenergic receptor agonist indicated for the treatment of spasticity in adults; however, its use in the pediatric population is considered off-label. In adults, the dose is gradually titrated until the desired reduction in muscle tone is achieved. Hypotension is a frequent adverse effect, but impaired liver function is not characteristic of alpha-2 adrenergic agonist overdose. We report a 2-year-old male affected with spastic quadriplegia (treated with clonazepam and tizanidine) and dysphagia (he was fed by nasogastric tube). Two days before admission caregivers ran out of clonazepam so they increased the tizanidine dose from 0.15 mg/kg/day to 1.6 mg/kg/day. Simultaneously his nasogastric tube fell out; therefore, he was unable to maintain proper oral nutrition and hydration. He presented to the emergency department hemodynamically unstable, with impaired consciousness and signs of severe dehydration. Blood tests revealed hepatic dysfunction without cholestasis and renal dysfunction. He was transferred to the pediatric intensive care unit. Treatment was mainly supportive, apart from tizanidine discontinuation. Metabolic and infectious diseases were ruled out so he was finally diagnosed as having liver, renal, and cardiovascular failure after tizanidine overdose, worsened by dehydration. His clinical status improved, and after 3 weeks he was discharged from the hospital, receiving clonidine instead of tizanidine to treat spasticity. Tizanidine overdose can result in serious complications that can be worsened because of patient comorbidities.

scholarly journals Infected open depressed skull fracture complicated with tetanus grade I in an unimmunized child: a rare case report with literature review

2021 ◽  
Vol 14 (1) ◽  
Author(s):  
Dzulfikar D. L. Hakim ◽  
Ahmad Faried ◽  
Adila Nurhadiya ◽  
Ericko H. Laymena ◽  
Muhammad Z. Arifin ◽  
...  
Keyword(s):  
Rare Case ◽  
Pediatric Population ◽  
Skull Fracture ◽  
Pediatric Intensive Care ◽  
Toxin Production ◽  
Clostridium Tetani ◽  
Anesthetic Care ◽  
Middle Income ◽  
Depressed Skull Fracture ◽  
Low Middle Income Countries

Abstract Background Tetanus is a rare disease caused by Clostridium tetani, which produces tetanolysin and tetanospasmin. In 2018, there were only approximately ten tetanus cases reported in Indonesia. Despite widespread vaccination, especially in low–middle-income countries, tetanus still occurs (mostly in adults) due to the lack of immunization related to religious tenets, cultural belief, or inaccessibility to medical care. In addition, tetanus in the pediatric population shows features which are quite distinct from the adult group. Case presentation We report a case of a 7-year-old girl presented to our institution with a history of falling 10 days prior to admission, with only skin laceration on her forehead. For 1 day prior to admission, the patient looked drowsy and difficult to be awakened, accompanied with stiffness of her jaw; we diagnosed her as an unimmunized child with an open depressed skull fracture of her frontal bone and wound infection complicated with “lockjaw.” Perioperative management of this rare case is reported and discussed. Conclusion The pediatric intensive care of such patients requires halting further toxin production, neutralization of circulating toxin, and control of the clinical manifestation induced by the toxin that has already gained access to the central nervous system. The basic tenets of anesthetic care in such case must be well-managed and planned prior to surgery.

scholarly journals Accidental tramadol ingestion in children admitted in tertiary care centre

2019 ◽  
Vol 8 (12) ◽  
pp. 2661
Author(s):  
Vadlakonda Sruthi ◽  
Annaladasu Narendra
Keyword(s):  
Pediatric Population ◽  
Care Center ◽  
Tertiary Care ◽  
Ventilatory Support ◽  
Case Series ◽  
Pediatric Intensive Care ◽  
Hemodynamic Instability ◽  
Tertiary Care Centre ◽  
Medical College ◽  
History Of

Background: Tramadol use has been increasing in the adult and pediatric population. Practitioners must be alert because Tramadol misuse can lead to severe intoxication in which respiratory failure and seizures are frequent. Overdoses can lead to death. We report 47 pediatric cases with history of accidental tramadol exposure in children.Methods: An observational, retrospective, single center case -series of children with a history of accidental tramadol exposure in children admitted in pediatric intensive care unit of tertiary care center, Niloufer Hospital (Osmania Medical College) Hyderabad, Telangana India.Results: Of 47 children, 22 (47%) are male and 25 (53%) were female. At presentation 11 (23%) had loss of consciousness, 14 (29%) seizures, 17 (36%) hypotonia was noted. Pupils were miotic in 22 (47%) mydriatic in 2 (4.2%) normal in rest of children. Hemodynamic instability noted in 13 (27.6%). Serotonin syndrome (tachycardia, hyperthermia, hypertension, hyper reflex, clonus) was noted on 5 (10.6%) children. Respiratory depression was seen in 4 (8%) children who needed ventilatory support. Antidote Naloxone was given in 7 children. No adverse reaction was noted with Naloxone. All 47 children were successfully discharged.Conclusions: Overdoses can lead to death and practitioners must be alert because of the increasing use of tramadol in the adult and pediatric population. The handling of the tramadol should be explained to parents and general population and naloxone could be efficient when opioid toxicity signs are present.

scholarly journals Did admissions caused by respiratory infections and asthma decrease during the COVID-19 pandemic?

2021 ◽  
Author(s):  
Zeynep Onay ◽  
Deniz Mavi ◽  
Yetkin Ayhan ◽  
Sinem Can Oksay ◽  
Gulay Bas ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Outpatient Clinic ◽  
Lower Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Respiratory Infections ◽  
Pediatric Population ◽  
Pediatric Intensive Care ◽  
Acute Bronchiolitis ◽  
Lower Respiratory Tract Infections ◽  
Tract Infections

Background: COVID-19 outbreak lead to nationwide lockdown on the March 16th, 2020 in Turkey. We aimed to quantitively determine the change in frequency of upper and lower respiratory tract infections and asthma in pediatric population associated with COVID-19. Methods: The electronic medical record data of pediatric population admitted to the emergency department (ED), outpatient and inpatient clinics and pediatric intensive care unit (PICU) were analyzed with the diagnosis of Influenza, upper and lower respiratory tract infections (URTI, LRTI) acute bronchiolitis and asthma. The data of the first year of the pandemic was compared with the previous year. Results: In total 112496 admissions were made between April 1, 2019 and March 31, 2021 in our hospital. A decline was observed in ED admissions (-73%) and outpatient clinic (-70%) visits, hospitalizations (-41.5%) and PICU admissions (-42%). The admissions with the diagnosis of Influenza and URTI had a decline from 4.26% to 0.37% (p=0.0001), and from 81.54% to 75.62% (p=0.0001), respectively. An increase was observed in the LRTI, acute bronchiolitis and asthma (from 8.22% to 10.01% (p=0.0001), from 2.76% to 3.07% (p=0.027) and from 5.96% to 14% (p=0.0001), respectively). Conclusions: A dramatic decrease was observed in the number of admissions to ED and inpatient clinics and outpatient clinic visits and PICU admissions, and, when the rates of admissions were compared, the general rate of admissions to ED showed a decrease while inpatient, outpatient clinics and PICU admissions demonstrated an increase during the pandemic.

P06.05 The Sitting Position in the Very Young Pediatric Population: Pearls and Pitfalls of a 10-Years’ Experience

2021 ◽  
Vol 23 (Supplement_2) ◽  
pp. ii25-ii25
Author(s):  
S Linsler ◽  
F Teping ◽  
J Oertel
Keyword(s):  
Posterior Fossa ◽  
Pediatric Population ◽  
Clinical Status ◽  
Skull Fracture ◽  
Special Focus ◽  
Posterior Fossa Surgery ◽  
Sitting Position ◽  
Endoscopic Techniques ◽  
Age At Surgery ◽  
Persistent Foramen Ovale

Abstract BACKGROUND To investigate pearls and pitfalls of the sitting positioning in the pediatric population with special focus on related morbidity and surgical practicability. MATERIAL AND METHODS A retrospective analysis of a prospectively maintained internal database was performed. All pediatric patients younger than 18 years at date of surgery, who underwent procedures in sitting position between 01/2010 and 10/2020 were included into this analysis. RESULTS A total of 42 of posterior fossa surgeries were performed in 38 children between 01/2010 and 10/2020. Mean age at surgery was 8.9 years (13 months - 18 years). Mean height and weight were 134.4 (± 30.2) cm and 36.6 (± 21.7) kg respectively. Three children (7.9%) were diagnosed with persistent foramen ovale. Electrophysiologic monitoring was unremarkable during positioning in all cases. Mean time needed for anesthesiologic preparation and positioning was 84.5 (± 20.6) minutes. Perioperative blood transfusion was needed in 5 cases (11.9%). Incidence of VAE was 11.9%. There was no VAE related severe complication. One child (2.4%) showed postoperative skull fracture and epidural bleeding due to skull clamp application. Clinical status immediately after surgery was favorable or stable in 33 of the cases (78.6%). CONCLUSION Attentive performance and an experienced surgical team provided; the sitting position remains a safe variant for posterior fossa surgery in the pediatric population. Precautious skull clamp application and appropriate monitoring is highly recommended. Considering eloquent aspects, the sitting position offers excellent anatomical exposure and is ideal for combination with endoscopic techniques.

scholarly journals Nasogastric tube, a warning sign for high-flow nasal cannula failure in infants with bronchiolitis

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Milena Siciliano Nascimento ◽  
Danielle E. R. Quinto ◽  
Gisele C. Z. Oliveira ◽  
Celso M. Rebello ◽  
Cristiane do Prado
Keyword(s):  
Hospital Admission ◽  
Nasogastric Tube ◽  
Ventilatory Support ◽  
Study Groups ◽  
High Flow ◽  
Nasal Cannula ◽  
Warning Sign ◽  
High Flow Nasal Cannula ◽  
Therapy Failure ◽  
Oral Nutrition

Abstract High-flow nasal cannula (HFNC) therapy is routinely used in the treatment of infants with bronchiolitis. This study sought to identify markers associated with failure of HFNC therapy that serve as warnings for early staging of other ventilatory support products. A retrospective study of infants with a diagnosis of bronchiolitis, receiving HFNC and admitted to the pediatric intensive care unit from January 2016 to June 2017, was conducted. The subjects were divided into two study groups according to the success or failure of HFNC therapy. Risk factors were assessed using the following variables: age, time between hospital admission and start of HFNC, equipment model, and the need for a nasogastric tube. Eighty-one infants were studied, and 18 (21.7%) of them exhibited therapy failure. The results of the logistic models showed that the chances of failure for patients requiring a nasogastric tube during HFNC use were more likely than those for patients with oral nutrition (OR = 8.17; 95% CI 2.30–28.99; p = 0.001). The HFNC failure was not associated with the device used (OR = 1.56; 95% CI 0.54–4.52; p = 0.41), time between hospital admission and HFNC installation (OR = 1.01; 95% CI 0.98–1.03; p = 0.73), or age (OR = 0.98; 95% CI 0.82–1.17; p = 0.82). Among late outcomes evaluated, the patients with therapy failure had longer total durations of O2 use (p < 0.001) and longer hospital stays (p < 0.001). The need to use a nasogastric tube during HFNC use was associated with HFNC therapy failure and can be considered as a marker of severity in children with bronchiolitis.

scholarly journals Whether the newly modified rhizotomy protocol is applicable to guide single-level approach SDR to treat spastic quadriplegia and diplegia in pediatric patients with cerebral palsy?

2019 ◽  
Vol 36 (9) ◽  
pp. 1935-1943
Author(s):  
Qijia Zhan ◽  
Xidan Yu ◽  
Wenbin Jiang ◽  
Min Shen ◽  
Shuyun Jiang ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Motor Function ◽  
Muscle Tone ◽  
Rehabilitation Program ◽  
Gross Motor ◽  
Single Level ◽  
Spastic Quadriplegia ◽  
Intensive Rehabilitation ◽  
Gmfcs Level

Abstract Purpose Our aim was to test whether the newly modified rhizotomy protocol which could be effectively used to guide single-level approach selective dorsal rhizotomy (SL-SDR) to treat spastic hemiplegic cases by mainly releasing those spastic muscles (target muscles) marked pre-operatively in their lower limbs was still applicable in spastic quadriplegic or diplegic cerebral palsy (CP) cases in pediatric population. Methods In the current study, we retrospectively conducted a cohort review of cases younger than 14 years of age diagnosed with spastic quadriplegic or diplegic CP who undergone our modified protocol-guided SL-SDR in the Department of Neurosurgery, Children’s Hospital of Shanghai since July 2016 to November 2017 with at least 12 months post-op intensive rehabilitation program (pre-op GMFCS level-based). Clinical data including demographics, intra-operative EMG responses interpretation, and relevant assessment of included cases were taken from the database. Inclusion and exclusion criteria were set for the selection of patients in the current study. Muscle tone (modified Ashworth scale) and strength of those spastic muscles (muscle strength grading scale), range of motion (ROM) of those joints involved, the level of Gross Motor Function Classification System (GMFCS), and Gross Motor Function Measure 66 items (GMFM-66) score of those cases were our focus. Results A total of 86 eligible cases were included in our study (62 boys). Among these patients, 61.6% were quadriplegic. Pre-operatively, almost 2/3 of our cases were with GMFCS levels II and III. Mean age at the time of surgery in these cases was 6.2 (3.5–12) years. Pre-op assessment marked 582 target muscles in these patients. Numbers of nerve rootlets tested during SDR procedure were between 52 and 84 across our cases, with a mean of 66.5 ± 6.7/case. Among those tested (5721 in 86 cases), 47.9% (2740) were identified as lower limb-related sensory rootlets. Our protocol successfully differentiated sensory rootlets which were considered to be associated with spasticity of target muscles across all our 86 cases (ranged from 3 to 21). Based on our protocol, 871 dorsal nerve rootlets were sectioned 50%, and 78 were cut 75%. Muscle tone of those target muscles reduced significantly right after SL-SDR procedure (3 weeks post- vs. pre-op, 1.7 ± 0.5 vs. 2.6 ± 0.7). After an intensive rehabilitation program for 19.9 ± 6.0 months, muscle tone continued to decrease to 1.4 ± 0.5. With the reduction of muscle tone, strength of those target muscles in our cases improved dramatically with statistical significance achieved (3.9 ± 1.0 at the time of last follow-up vs. 3.3 ± 0.8 pre-op), and as well as ROM. Increase in GMFCS level and GMFM-66 score was observed at the time of last follow-up with a mean of 0.4 ± 0.6 and 6.1 ± 3.2, respectively, when compared with that at pre-op. In 81 cases with their pre-op GMFCS levels II to V, 27 (33.3%) presented improvement with regard to GMFCS level upgrade, among which 4 (4.9%) even upgraded over 2 levels. Better results with regard to upgrading in level of GMFCS were observed in cases with pre-op levels II and III when compared with those with levels IV and V (24/57 vs. 3/24). Upgrading percentage in cases younger than 6 years at surgery was significantly greater than in those older (23/56 vs. 4/25). Cases with their pre-op GMFM-66 score ≥ 50 had greater score increase of GMFM-66 when compared with those less (7.1 ± 3.4 vs. 5.1 ± 2.8). In the meanwhile, better score improvement was revealed in cases when SDR performed at younger age (6.9 ± 3.3 in case ≤ 6 years vs. 4.7 ± 2.7 in case > 6 years). No permanent surgery-related complications were recorded in the current study. Conclusion SL-SDR when guided by our newly modified rhizotomy protocol was still feasible to treat pediatric CP cases with spastic quadriplegia and diplegia. Cases in this condition could benefit from such a procedure when followed by our intensive rehabilitation program with regard to their motor function.

scholarly journals Peripherally Inserted Central Catheters in Pediatric Patients Performed by Radiologists Using Fluoroscopy

2021 ◽  
Vol 1 (2) ◽  
Author(s):  
Amanda Shane ◽  
Zahra Premji
Keyword(s):  
Ultrasound Guidance ◽  
Pediatric Patients ◽  
Pediatric Population ◽  
Central Venous Access ◽  
Pediatric Intensive Care ◽  
Venous Access ◽  
Central Catheter ◽  
Central Venous ◽  
Central Catheters ◽  
Venous Access Devices

Evidence from 2 clinical studies showed that there was no difference in the rates of infection and complications between peripherally inserted central catheter (PICC) insertion at the bedside and insertion in Interventional Radiology (IR) suites. However, each of these studies focused on small subgroups of the larger pediatric population and had other methodological limitations. Evidence from 1 clinical study in a single quaternary, non-cardiac, pediatric intensive care unit suggested that the median time from PICC line order to successful insertion was longer for lines placed in the IR compared to at the bedside. Two guidelines were identified that recommend ultrasound guidance for insertion of central venous access devices (CVAD), including PICCs: 1 was aimed at all pediatric patients and 1 was aimed at onco-hematological pediatric patients who had numerous quality limitations.

scholarly journals Cardiac resynchronization therapy in a child with tetralogy of Fallot

2020 ◽  
Vol 30 (1) ◽  
pp. 73-77
Author(s):  
Horia Stefan Rosianu ◽  
Razvan Olimpiu Mada ◽  
Simona Oprita ◽  
Adrian Stef ◽  
Manuel Chira ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Resynchronization Therapy ◽  
Tetralogy Of Fallot ◽  
Pediatric Population ◽  
Clinical Status ◽  
Pulmonary Regurgitation ◽  
Cardiac Resynchronization ◽  
Heart Team ◽  
Resynchronization Therapy ◽  
Permanent Pacing

Cardiac resynchronization therapy is a common option in adult patients with heart failure and conduction abnormalities. Specific selection criteria for pediatric population are lacking. We report the case of a 14-year-old boy with signifi cant pulmonary regurgitation subsequent to corrected tetralogy of Fallot and single chamber permanent pacing which presented with heart failure symptoms. Careful management was planned by a Heart Team including pediatric cardiologist, cardiac surgeon, interventional cardiologist and anesthesiologist. After undergoing cardiac surgery with complete correction of the pulmonary regurgitation and upgrade to a triple chamber pacing, the patient was discharged in good clinical status.

scholarly journals Gastrointestinal manifestations as the initial presentation of COVID 19 in pediatrics

2020 ◽  
Vol 10 (3) ◽  
Author(s):  
Ana Leticia Souza ◽  
Flavia Matos ◽  
Rosana Flintz ◽  
Roberta Marliere ◽  
Mariana Presti ◽  
...  
Keyword(s):  
Pediatric Population ◽  
Gastrointestinal Symptoms ◽  
Pediatric Intensive Care ◽  
Signs And Symptoms ◽  
Positive Serology ◽  
Hospital Unit ◽  
Gastrointestinal Conditions ◽  
Clinical Presentations ◽  
Starting Point ◽  
Initial Symptoms

Initial research on SARS-COV 2 (Severe Acute Respiratory Syndrome Coronavirus 2) appeared to demonstrate that children infected with the virus remained asymptomatic or had only mild to moderate conditions. The most common symptoms were fever and cough. However, in a later phase of the pandemic, numerous other aspects of clinical presentation in the pediatric public were observed, especially gastrointestinal conditions. In the present study, patients monitored at the Pediatric Intensive Care Unit of the Hospital Estadual Adão Pereira Nunes from April 17, 2020 until June 17, 2020, who had detectable PCR-RT (Polymerase Chain Reaction -Trasncriptase) or positive serology for COVID 19 (Coronavirus disease 19). This is a hospital unit that is not a reference for COVID 19, and its target audience is trauma victims.The initial symptoms of most hospitalized patients with clinical suspicion were fever and gastrointestinal symptoms, with significant abdominal pain standing out, mimicking acute abdomen. Signs and symptoms that differ from adults, who have respiratory manifestations as a starting point. Based on the recognition of the different clinical presentations of SARS-COV 2 in the pediatric population, an early diagnosis is possible, with better conduction and outcome.

Sign in / Sign up

Export Citation Format

Share Document