ABSTRACT
A 22-month-old female infant with an accidental methanol poisoning is presented. Her serum methanol level was 25 mg/dl. The clinical and biochemical features were as follows: coma, hyperventilation, metabolic acidosis, paralytic mydriasis, hypoglycemia, increased anion and osmolal gap, DIC, elevated CPK and LDH, anemia and abnormal EEG. She was treated with bicarbonated solutions and continuous infusion of ethanol. The pathophysiology, diagnosis and treatment of this poisoning is herein revised. DIC and enzymatic alterations are specially remarked.
Subject(s)
Methanol/poisoning , Apnea/chemically induced , Coma/chemically induced , Ethanol/administration & dosage , Female , Humans , InfantABSTRACT
A comparative study of two patients, one affected by haemorrhagic shock and encephalopathy (HSE) and the other by heatstroke is reported. Both presented shock, disseminated intravascular coagulation, neurological damage and hepatopathy. A lowered alpha 1-antitrypsin concentration as well as a slightly increased circulating immune complexes and complement consumption were observed in the HSE patient but not in the heatstroke one. In both, cultures for bacteria were negative, the viral serology was non-specific and hepatitis A and B studies were negative. HSE patient died. A possible relationship between HSE, heatstroke, malignant hyperthermia and halothane hepatitis is postulated. Fever, potentially hepatotoxic drugs or unknown agents (HSE) might trigger this clinical picture.
Subject(s)
Brain Diseases/etiology , Heat Exhaustion/etiology , Shock, Hemorrhagic/etiology , Female , Heat Exhaustion/diagnosis , Humans , Infant , Liver/pathology , Male , Shock, Hemorrhagic/diagnosisSubject(s)
Foreign Bodies/complications , Stomach , Foreign Bodies/diagnostic imaging , Humans , Infant , Male , Radiography , RiskABSTRACT
Four cases of membranous laryngotracheobronchitis (MLTB) are presented. This entity is defined as an inflammation of larynx, trachea and bronchi, with mucopurulent membranes adhered to subglottic space wall. Radiological study shows irregularity of the proximal tracheal mucosa as well as adhered membranes resembling foreign bodies. Two out of the four children suffered from measles and one had staphylococcal pleuropneumonia. Tracheal aspirate obtained by laryngoscopy yielded S. aureus in two cases, and beta-lactamase positive H. influenzae in another. All patients required nasotracheal intubation and antibiotherapy. Characteristics of MLTB are discussed, pointing out its difference from viral laryngotracheobronchitis. Possibility of MLTB being initially a viral process undergoing bacterial superinfection later on is analyzed.
Subject(s)
Bronchitis/etiology , Croup/etiology , Laryngitis/etiology , Tracheitis/etiology , Virus Diseases/complications , Airway Obstruction/etiology , Anti-Bacterial Agents/therapeutic use , Bacterial Infections/complications , Child , Child, Preschool , Combined Modality Therapy , Humans , Infant , Intubation, Intratracheal , Measles/complicationsABSTRACT
Serum phosphorus showing anomaly low values: 2.47 +/- 0.41 mg/dl (p less than 0.001) were determined within the first hours of admittance in 18 children with meningococcal infection. In another 10 renal clearance was performed founding phosphatemias of 2.35 +/- 0.37 mg/dl (p less than 0.002), determining FE of electrolytes. Both groups were compared with another one without infectious pathology which presented normal phosphatemia. Most serious cases had the most severe hypophosphatemia (p less than 0.01); eight children presented hyperphosphaturia up to 52.7 mg/Kg/day and TRP lower than 80%; six asymptomatic hypocalcemia, two hypomagnesemia; FE of potassium was elevated in three children, FE of calcium in one child and FE phosphorus in eight children. Monosodium phosphate was administered to two children with myocarditis as they presented signs of hypophosphatemia. All of them normalized biochemically in 3-4 days. Possible physiopathological mechanisms of this situation are discussed, considering the possibility that hormonal and/or tubular mechanisms take part in the lowering of phosphorus. Necessity of monitoring serum and urine phosphorus in these children is emphasized.
Subject(s)
Meningitis, Meningococcal/blood , Phosphorus/blood , Child, Preschool , Humans , InfantABSTRACT
Authors present their experience in 4 children with acute tuberculous meningitis. All of them were in deep coma, with abnormal motor responses, documented increased intracranial pressure and severe hydrocephallia. External ventricular drainage during 18 to 35 days, plus specific antituberculous treatment was performed in all of them without untoward effects. Clinical evolution was excellent. This particular type of tuberculous meningitis and its' physiopathology are reviewed. Importance of computed cranial tomography in early diagnosis and treatment and follow up evaluation are stressed.
Subject(s)
Tuberculosis, Meningeal/therapy , Antitubercular Agents/therapeutic use , Cerebrospinal Fluid Shunts , Child, Preschool , Dexamethasone/therapeutic use , Drainage , Female , Humans , Hydrocephalus/etiology , Hydrocephalus/therapy , Infant , Male , Phenobarbital/therapeutic use , Tomography, X-Ray Computed , Tuberculosis, Meningeal/diagnostic imagingABSTRACT
A 4-3/12 old boy with a hypophosphoremic coma (serum phosphorus: 0.4 mg./dl.) is presented. The favoring conditions appear to be related to acute renal failure in polyuric phase with high phosphorus excretion, low phosphorus intake, rapid transit from a catabolic to an anabolic state with previous malnutrition and parenteral feeding, oral aluminum hydroxide gel administration and lung infectious disease. The clinical, biochemical data, evolution and physiologic mechanisms are commented, specially those of erythrocyte, leucocyte and platelet disfunction related to ATP, AMP and 2.3 DPG deficiency. Proteinuria and hematuria during phosphorus depletion are emphasized. The alarm symptoms and treatment are indicated.
