Traumatic brain injury inducing swift transition from syndrome of inappropriate antidiuretic hormone secretion to central diabetes insipidus: a case report.

Heavy traumatic brain injury (TBI) may lead to the manifestation of either syndrome of inappropriate secretion of antidiuretic hormones (SIADH) or central diabetes insipidus (CDI). We present a case of TBI where SIADH transformed into CDI within a remarkably short timeframe. A previously healthy 4-yr-old boy was admitted to our hospital with hyponatremia and elevated urinary sodium level on the day following a traumatic head injury. Within 150 min after initiating SIADH treatment, a significant increase in urine volume and a decrease in urinary sodium levels were observed. Therefore, the treatment plan was modified to include desmopressin. By the 5th day of admission, the urine volume gradually stabilized and normalized without the need for further desmopressin treatment. Mild TBI can give rise to various conditions that may undergo rapid changes. Closely monitoring serum and urine electrolytes, along with urine volume, is imperative for the administration of appropriate and timely treatment.

Velocity-based target flow rate for high-flow nasal cannula oxygen therapy.

BACKGROUND: The aim of this study was to assess retrospectively whether the average inspiratory flow velocity-based initial flow rate in high-flow nasal cannula (HFNC) therapy could be well tolerated and safely used for infants and children hospitalized with moderate to severe respiratory failure. METHODS: Thirty-three patients without underlying diseases (22 males; 67%), hospitalized to receive HFNC therapy for infection-related respiratory failure, were analyzed. The median age was 2 months (interquartile range, 1 month to 1 year). Patients with dyspnea and carbon dioxide partial pressure (pCO2 ) >50 mmHg or venous blood pH <7.320, combined with pulse oximetry arterial oxygen saturation <92%, were included. We set target flow rates calculated from the average inspiratory flow velocity, starting at the actual initial flow rates, and these were subsequently adjusted if necessary. RESULTS: One patient could not tolerate the cannula. Of the remaining 32 patients, 81% (n = 26) had an actual initial flow rate within 1 L of the target flow rate; these patients were evaluated for changes in the fraction of inspired oxygen (FITarget flow rate tableO2 ), pH, and pCO2 values after 24 h. Three patients required a higher fraction of inspired oxygen, one showed a persistent pH < 7.320, and seven exhibited pCO2 >50 mmHg. No patient required non-invasive positive-pressure ventilation, and one required intubation. Pneumothorax was not reported in any patient. CONCLUSIONS: The average inspiratory flow velocity-based initial flow rate was well-tolerated without sedation, and there were no severe complications. Starting at this flow rate would improve the use of HFNC therapy in the pediatric ward, possibly reducing the need for more invasive modes of ventilation.

ß2 microglobulin and lactate dehydrogenase are indices of different features of Mycoplasma pneumoniae-associated community-acquired lower respiratory tract infection for severity evaluation in children.

Using the hospital records, we retrospectively assessed whether urinary ß2 microglobulin/creatinine ratio (UBCR) and lactate dehydrogenase (LD) values could be used to estimate the severity of Mycoplasma pneumoniae-associated lower respiratory tract infection (MP-LRTI). We studied 48 patients with MP-LRTI (median age, 7.5 years; range, 3-14 years) admitted to Kagoshima City Hospital and examined the relationships of the UBCR or LD values with fever and pulmonary tissue damage (hypoxemia and severity assessments on chest radiographs). Patients were assigned to four groups based on whether they had fever and/or hypoxemia. Patients with high fever showed significantly higher UBCR values than those without (P < 0.05), whereas those with hypoxemia showed higher LD values than those without (P = 0.001). The maximum body temperature on admission was closely associated with the UBCR but not with LD levels. In chest radiography assessments, LD levels were significantly higher in patients with severe than mild or moderate MP-LRTI. A cut-off LD level of 530 IU/L showed a very high sensitivity (100%) and specificity (93%). Although UBCR values were higher in patients with severe MP-LRTI, the differences were not statistically significant. Our study shows that the UBCR is associated with body temperature, whereas LD levels may serve as an index of pulmonary tissue damage in children with MP-LRTI.