Fluid therapy in paediatric surgical emergencies a simplified scheme and its clinical application

A scheme is presented for fluid and electrolyte therapy in paediatric surgical patients. It was applied on 31 infants and children undergoing various surgical procedures. During application of the scheme frequent clinical assessment as well as laboratory estimation of serum electrolytes were undertaken. The clinical response was satisfactory in the majority of cases. The scheme could be applied safely to children and infants requiring emergency operation without the help of laboratory estimation except in few complicated cases. The response to intravenous fluid therapy in 31 newly born infants and children undergoing major surgery has been studied. The plan of treatment was designed to provide for correlation of dehydration if present and for maintenance of normal fluid and electrolyte levels. Solutions of glucose and of sodium chloride in varying concentrations were used to relief the dehydration, resume urinary flow and restore tissue fluids. Potassium salts were added to these solutions at the proper time. The scheme included an initial phase of 40-80 ml/kgm body weight, a maintenance quantity of 100-150 ml/kgm body weight and a replacement therapy for losses of 20 ml or more per kgm body weight. Cases with marked distension and low sodium levels and those with low potassium serum levels were given special attention. Laboratory estimations of sodium and potassium serum levels were undertaken on admission, and on the first and second post-operative days. Clinical progress in response to intravenous fluid therapy was satisfactory in the majority of cases. Since confidence in the present plan of treatment has increased, it can now be applied to children and infants requiring emergency operation without the help of laboratory estimation except in some complicated cases

Intestinal obstruction in the new-born

This paper deals with 20 cases of neo-natal intestinal obstruction admitted in the paediatric surgical unit during the period from 1958 to 1965. Of these, 5 cases were due to Hirschsprung's disease; 9 cases were due to intestinal atresia, 4 cases were due to malrotation and 2 were due to obstructed Omphalocele. The clinical picture, diagnosis and management are described. Intestinal obstruction in the newborn is a difficult and important pediatric and surgical problem. Most cases are due to congenital obstructive anomalies. Twenty cases of intestinal obstruction in the neonatal period are presented and discussed. The operative management and results of treatment are outlined

Urinary xanthurenic acid in acute diffuse glomerulonephritis its relation to the state of pyridoxine

Through estimation of urinary xanthurmic acid in cases of acute diffuse glomerulonephritis, tryptophan metabolism was found to be disturbed in these cases. This disturbance could be reversed by administration of pyridoxine in big doses. Pyridoxine is also thought to be therapeutically beneficial in restoring heart failure, and hypertension to normal in acute glomerulonephritis. Urinary xanthurenic acid was measured in 8 cases of uncomplicated and 21 cases of complicated acute diffuse glomerulonephritis. In the former cases the level of UXA was found to be 564 micro g.% i.e. coinciding with the normal level. In the latter cases, 18 cases, complicated by heart failure and hypertension had an average of UXA of 1750 micro g;%; and 3 cases complicated with heart failure but without hypertension had an average level of 1575 micro g.%. On giving ordinary treatment for nephritis the level of UXA returned to normal in an average of 6 days together with recovery of heart failure and hypertension. On giving pyridoxine in a dose of 25 mg. intramuscularly every 6 hours together with the ordinary treatment the level of UXA returned to normal in an average of 3 days. This either coincided with recovery of heart failure and hypertension or preceded it by 1-3 days. On giving pyridoxine in massive doses unaided by any other medication, the heart failure and the blood pressure were restored to normal in an average of 2 days. A possible beneficial effect of pyridoxine in heart failure and hypertension due to acute nephritis is suggested. [We are indebted to Roche laboratories for the supply of Benadon "Vitamin B6" Roche]

haemolytic uraemic Syndrome report of a case with a comment on the pathogenesis of the syndrome

An eight months old male infant with the haemolytic uraemie syndrome is described. The aetiology, pathogenesis, prognosis and management of this syndrome are discussed