Acta paediatrica
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Review Case Reports
Successful therapy of paediatric ethylene glycol poisoning: a case report and annual survey by a regional poison centre.
Severe poisoning with ethylene glycol, often used as antifreeze, is a rare, life-threatening event. Neurological symptoms are accompanied by metabolic acidosis with elevated anion gap and osmotic gap. We report on a 7-year-old boy suffering from severe ethylene glycol intoxication. Early diagnosis based on typical clinical signs and rapid initiation of specific therapy with ethanol resulted in complete and rapid recovery without haemodialysis becoming necessary. While one laboratory initially had not been able to detect ethylene glycol in the patient's blood, an ethylene glycol serum level of 3900 mg/L was measured by a second laboratory, the highest value ever reported in the scientific literature for paediatric cases. Ethylene glycol poisoning is verified by quantitative glycol analysis in serum, but only few laboratories are able to perform this investigation in emergency cases. Therefore, in the beginning diagnosis has to be based on patient's history and clinical signs. Every substantial suspicion of ethylene glycol poisoning has to be treated with an antidote (fomepizole or ethanol) immediately. ⋯ Ethylene glycol poisoning is rare in the paediatric age group in our series of glycol poisonings. One should keep in mind, that early diagnosis and treatment due to clinical signs is important and haemodialysis usually is not necessary.
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Comparative Study
Thyroid function in children with sepsis and septic shock.
A prospective study was conducted to determine thyroid hormone levels and their relationship to survival in children with septic shock and sepsis. ⋯ Children with septic shock had lower levels of T3, T4, fT3, fT4 and TSH compared to those with sepsis. Findings of our study suggest that derangement of thyroid functions in children is not an important factor contributing to the severity of septic shock.
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To test that age is of influence on midazolam requirements during prolonged mechanical ventilation in critically ill children. ⋯ Our data showed that children between 1 and 4 years needed higher doses of midazolam as compared to children who were younger and older. Furthermore, we observed that midazolam alone is a poor sedative for all age groups. The influence of and mechanisms for possible age related effects on midazolam requirements remain to be elucidated, as well as the position of midazolam as a first line drug for PICU sedation.
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In the process of validation of the Swedish translation of the Post-Hospital Behaviour Questionnaire (PHBQ) to assess its relation to the Child Behaviour Checklist (CBCL) and to describe its relation to sociodemographic factors. ⋯ There is an association between PHBQ and CBCL which is weaker for older children. The reason for this might be that PHBQ is more sensitive in the younger age group and to minor changes in behaviour. Children younger than 5 years of age or living in a one parent family or not living in rural areas appear to have higher incidence of problematic behaviour in a 2 week follow up after anaesthesia.