ABSTRACT
Transcatheter occlusion of patent ductus arteriosus has become a safe and successful technique, but it's not free of complications. We present the case of a two-year-old boy who underwent routine transcatheter closure of his patent ductus arteriosus, using a "coil" device. Twenty hours later he developed severe persistent hemolysis in association with residual ductal flow. Patient's clinical situation became stable when the device was removed. Pulmonary embolization of the device and hemolysis are the main complications of percutaneous closure of the patent ductus arteriosus. Hemolysis occurs rarely (0.5%) and is always associated with the presence of residual ductal flow. Several approaches to this problem have been described. Mild cases may require no intervention; however, when severe hemolysis is present, removal of the device may be needed, proceeding with surgical repair of the patent ductus arteriosus.
Subject(s)
Catheter Ablation/adverse effects , Ductus Arteriosus, Patent/surgery , Hemolysis , Child, Preschool , Humans , MaleABSTRACT
OBJECTIVE: The aims of this work were to describe the therapeutic options available for severe hyperammonemia in children when ammonium levels are so high that the child's neurologic future or even their life is compromised. In addition, a comparison of the relative efficacy of each therapeutic method is made. PATIENTS AND METHODS: We present six cases, five of which suffered from inborn errors of metabolism and a six which presented with Reye's syndrome, all of whom presented or developed hyperammonemic coma. Their initial ammonium levels fluctuated between 300 and more than 2000 micrograms per deciliter. The treatment was made with exchange transfusion (ET), ET and peritoneal dialysis (DP) together or hemodialysis (HD). RESULTS: Peritoneal dialysis was the method that obtained the greatest reduction in plasma ammonium levels. However, the quickest reduction was observed with ET and HD. There were no significant complications with any of the methods except for hemodynamic deterioration in one patient during HD. CONCLUSIONS: We believe that HD is the treatment of choice for these patients because it is able to obtain a quick and lasting clearance of plasma ammonium. However, this method is not always available and has not been used very often in small babies. In these cases, the combined use of ET and DP can be very useful.
Subject(s)
Ammonia/metabolism , Metabolism, Inborn Errors/therapy , Child , Child, Preschool , Exchange Transfusion, Whole Blood , Female , Humans , Infant, Newborn , Peritoneal Dialysis , Renal DialysisSubject(s)
Aldosterone/deficiency , Glomerulonephritis/complications , Renin/deficiency , Adolescent , Child , Glomerulonephritis/blood , Humans , Male , Renin/bloodABSTRACT
Authors report five patients with lymphoproliferative diseases who suffered from metabolic and renal disorders hyperuricemia, hyperphosforemia, hyperkaliemia, hypocalcemia and azotemia) during initial phase of chemotherapy. They comment on measures to prevent these disorders and the need of hemodialysis in some cases.
