ABSTRACT
OBJECTIVE: To determine the prevalence of hyponatremia at diagnosis in patients with cystic fibrosis and identify the factors associated with changes in serum sodium concentration over time. STUDY DESIGN: This longitudinal study investigated whether variations in serum sodium concentration were associated with age, diet, infection status, and climate/temperature. Multivariate analysis was performed using the random-effects model for longitudinal data. RESULTS: Hyponatremia at diagnosis was observed in 19 of the 20 patients (95%). Factors identified as associated with variations in serum sodium concentration were diet (P = .008) and climate/temperature (P = .005). Intake of solid foods appeared to greatly increase the serum sodium concentration (increase of 5 mEq/L after introduction of solid foods); however, a confounding factor between diet and age cannot be definitively ruled out. Climate/temperature contributed in an inverse way; a 1°C-increase in ambient temperature was associated with a 0.5-mEq/L decrease in serum sodium concentration. CONCLUSION: Infants with cystic fibrosis who feed on breast milk or formula and live in a high-temperature environment are at increased risk for hyponatremia, even when receiving a higher salt intake in accordance with recommendations.
Subject(s)
Cystic Fibrosis/blood , Hyponatremia/complications , Sodium/blood , Breast Feeding , Child, Preschool , Cystic Fibrosis/diagnosis , Female , Humans , Hyponatremia/therapy , Infant , Infant Food , Infant Formula , Male , Sodium Chloride/administration & dosage , Tropical ClimateABSTRACT
OBJECTIVE: To review the literature on portal vein thrombosis in children and adolescents, focusing on its diagnosis, complications and treatment. SOURCES OF DATA: The medical literature of the past 10 years was reviewed using the PubMed and MEDLINE search engines, with major focus on portal vein thrombosis and its clinical outcomes. The following keywords or expressions were used for the web search: portal vein thrombosis, extra-hepatic portal vein obstruction, prognosis, children, portal hypertension, esophagogastric varices. Additionally, we also reviewed the articles cited in the references of the initially selected papers, as well as relevant textbooks. SUMMARY OF THE FINDINGS: Portal vein thrombosis is one of the most common causes of portal hypertension among children. The initial clinical manifestation is characterized either by episodes of upper gastrointestinal bleeding or by splenomegaly on routine clinical examination. The major complications include upper gastrointestinal bleeding, hypersplenism secondary to splenomegaly, growth retardation, and portal biliopathy. The diagnosis is made by abdominal Doppler ultrasonography. Treatment is targeted at the complications and includes primary and secondary prophylaxis against upper gastrointestinal bleeding (which results from the rupture of esophageal varices), and portosystemic shunting in selected cases. CONCLUSIONS: Portal vein thrombosis is one of the major triggers of upper gastrointestinal bleeding in children. Bleeding episodes have a remarkable effect on the quality of life of affected patients. Thus, appropriate diagnosis and treatment are needed in order to reduce morbidity and mortality.
Subject(s)
Portal Vein , Venous Thrombosis , Adolescent , Child , Diagnosis, Differential , Humans , Hypertension, Portal/etiology , Hypertension, Portal/therapy , Venous Thrombosis/complications , Venous Thrombosis/diagnosis , Venous Thrombosis/therapyABSTRACT
OBJETIVO: Apresentar uma revisão atualizada de trombose de veia porta na infância e adolescência, enfatizando o diagnóstico, suas complicações e tratamento. FONTE DOS DADOS: Foi realizada revisão da literatura, dos últimos 10 anos, através de pesquisa bibliográfica na Internet nos principais sites de busca médica, como o PubMed e MEDLINE, com enfoque na doença trombose de veia porta e suas repercussões clínicas. As principais palavras-chave e expressões pesquisadas foram: portal vein thrombosis, extra-hepatic portal vein obstruction, prognosis, children, portal hypertension, esophagogastric varices. Além disso, foram consultados os artigos citados nas referências dos trabalhos selecionados na pesquisa inicial e dos livros textos. SíNTESE DOS DADOS: A trombose de veia porta é uma das causas mais comuns de hipertensão porta na infância. A apresentação clínica inicial pode ser através de episódios de hemorragia digestiva ou da presença de esplenomegalia em exame clínico de rotina. As principais complicações são a hemorragia digestiva, hiperesplenismo secundário à esplenomegalia, retardo de crescimento e biliopatia portal. O diagnóstico é realizado através da ultra-sonografia abdominal com Doppler. O tratamento é direcionado para as complicações, incluindo profilaxia primária e secundária de hemorragia digestiva, conseqüente à ruptura de varizes esofágicas, e derivações porto-sistêmicas, em casos selecionados. CONCLUSÕES:A trombose de veia porta é uma das causas mais importantes de hemorragia digestiva em crianças. Esses episódios acarretam impacto importante na qualidade de vida dos pacientes acometidos. Dessa forma, uma abordagem diagnóstica e terapêutica adequada é desejável na tentativa de se reduzir a morbimortalidade.
