Delirium due to scopolamine patch in a 4-year-old boy.

The scopolamine patch is usually used to reduce postoperative nausea and vomiting associated with anesthesia and/or surgery. It is also commonly used for the prevention of motion sickness. Transdermal scopolamine patches have been used for decades and there are few reports in the literature of toxic psychosis associated with the product. Most documented cases of acute psychosis following administration of scopolamine or other anticholinergic agents have been from the adult population. Here we present a 4-year-old boy with deteriorated cognitive function and changed mental status acutely. Besides flushing skin and psychotic behaviors including bizarre actions, hallucinations, aggressive behavior, hyperactivity, and incoherent speech were also noticed. Symptoms and signs were resolved after removal of scopolamine patch and conservative management. This case is possibly one of the youngest patients to exhibit such toxic effects. We hope to relay information about common agents with anticholinergic effects to clinical practitioners and remind that drug-induced psychosis should be considered in children with acute changes in behavior.

Cyclic vomiting syndrome in Taiwanese children.

BACKGROUND/PURPOSE: Cyclic vomiting syndrome (CVS) is a periodic and Stereotypic pattern of intractable nausea or vomiting episodes, which has been well-recognized in previous decades, although the actual pathogenesis is still unclear. Recurrent, discrete, but self-limited symptoms of nausea and vomiting bother children, and increase the cost of family and health care. This report described the clinical features of patients who fulfill the diagnostic criteria for CVS. METHODS: This was a retrospective study that reviewed the medical records of children with CVS in our department from 1992 to 2008. The clinical features and results of long-term follow-up of these children were analyzed. RESULTS: Twenty-four patients (16 boys and 8 girls) were enrolled in this study. The mean age of onset was 6.8 ± 3.3 years (2.2-15.4 years), and the mean interval from onset to proper diagnosis was 2.1 ± 2.2 years. Comparing initial presentation and latest condition, the duration of attack was 4.1 ± 2.2 days and 0.8 ± 1.4 days, respectively, and the admission/emergency department visit dropped from 2.3 ± 2.0 to 0.6 ± 1.1 times per year. Twenty-three of 24 patients had been treated with amitriptyline, cyproheptadine, or propranolol. Nine patients (38%) had no symptoms in the past 12 months. CONCLUSION: The diagnosis of CVS must be based on the detailed history of the clinical manifestations of vomiting pattern, complete symptom-free intervals between the attacks, and absence of neurological, gastrointestinal, or metabolic abnormalities. Most of our patients improve when they grow up, but prompt diagnosis and early intervention may improve quality of life.

Fatty acid composition of Taiwanese human milk.

BACKGROUND: The purpose of this study was to analyze quantitatively the fatty acid composition of the milk of Taiwanese women. METHODS: Two hundred and sixty-nine human milk specimens were obtained from 240 Taiwanese mothers, aged 19-41 years, and subjected to chromatographic analysis. RESULTS: Milk specimens were pooled by the mothers' districts of residence and lactation stages, at 0-11 days, 22-45 days, 46-65 days and 66-297 days after delivery. The fatty acid composition was expressed as weight percentage of all fatty acids detected with C8-C24 chain length. More than 80% of the fatty acids were composed of lauric, myristic, palmitic, stearic, oleic and linoleic acids. The amount of saturated fatty acid was 36.7%. With regard to essential fatty acids, the amount of linoleic acid (LA) was 22% and that of linolenic acid (ALA) was 1.8%, both levels being higher than in human milk from Western countries. However, the ratio of LA/ALA remained at 13:1 for the whole duration of lactation. It has been reported that mothers with high fish consumption have a high content of docosahexaenoic acid and eicosapentaenoic acid in their milk, and we found this phenomenon occurring in our study. The percentage of docosahexaenoic acid and eicosapentaenoic acid in Taiwanese human milk was 0.79% and 0.17%, respectively. CONCLUSION: Fatty acid composition in human milk varies during lactation. With regard to essential fatty acids, the amount of LA was 22% and that of ALA was 1.8%, both levels being higher than in human milk from Western and other Asian countries.