RESUMO
Pediatric populations are the most vulnerable group with regard to rational drug prescribing since many new drugs aremarketed without any proper pharmacovigilance study, thereby increasing the risk of toxicity. The study was aimedto determine the adverse drug reaction (ADR) pattern in the pediatric population over a period of 6 months. A total of200 patients were enrolled in the study, 15 patients were suspected with ADRs and were confirmed by the physiciansattending the pediatric department. Out of 15 cases, eight were male patients (53.33%) and seven were female patients.46.66% of ADRs were affected in the skin and subcutaneous tissue, followed by the gastrointestinal system (40%).Most common group of showing ADRs were found to be antibiotics (66.65%), followed by anticonvulsants (19.99%).Type B reactions were the most commonly observed ADRs, of which subtype 1 was of the common type. 73.33% ofthe events were in the probable category, 20% of the events were in the possible category, and 6.66% events were inthe definite category and also most of the ADRs were of mild varieties (60%), followed by moderate (40%). 73.33% ofADRs were cured and 26.66% were getting better with further therapeutical management. The study indicated the needfor a rigid ADR monitoring among pediatric patients to ensure the safety of drug therapy. Various pharmacovigilanceawareness programs should be conducted to increase the spontaneous reporting of ADRs.
RESUMO
Aim: Our aim is to present a case of hypernatremia which has led on to a flaccid quadriparesis due to brain stem demyelination. Rapid correction of hypernatremia as a cause for pyramidal tract demyelination is not documented in the literature. Presentation of Case: A 53 year old male was brought to the emergency services with suspected stroke. He was treated with intravenous mannitol and oral glycerine from the primary health centre. We detected hypoglycemia (blood sugarwas 50mg/dl-Ref range: ≤70mg%) and dextrose was given intravenously. Subsequently the patient went into a hypernatremic state with serum sodium 170milli equivalents /liter which was corrected rapidly. This was corrected over 48 hours to 140milli equalents/litre. The rate of correction exceeded 0.62millimols/liter/hour (Ideal: 0.5 mmol/L/h). On the 6th day the patient developed acute quadriparesis. Magnetic resonance imaging (MRI) of brain revealed bilateral symmetric demyelination of the corticospinal tracts. Over six months the neurological deficit improved with complete resolution of the changes in previous Discussion: Osmotic Demyelination Syndrome (ODS) has been a recognized complication of rapid correction of hyponatremia. Experiments in animals and clinical experience suggest that correction of chronic hyponatremia should be kept at a slow rate to combat this complication. The characteristic sites include pons and basal ganglia. Such a complication has not been described due to rapid correction of hypernatremia.This is probably the first case report in the literature where acute onset of quadriparesis resulted from demyelination of the pyramidal tract consequent to a rapid correction of hypernatremia. We had to wait about 6 months for the patient to obtain a complete functional recovery and the neuro imaging was repeated after 6 months to confirm the disappearance of the initial findings thus implicating rapid correction of hypernatremia as the cause of his morbidity. Conclusion: This is the first time extrapontine reversible myelinolysis due to rapid correction of hypernatremia has been documented. To prevent this potentially fatal complication it will be prudent if hypernatremia is corrected slowly.