Clinical pediatrics
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Clinical pediatrics · Nov 2008
Case ReportsCongenital central alveolar hypoventilation syndrome (Ondine's curse) with survival into adulthood.
Ondine's curse or central alveolar hypoventilation (CCAH) syndrome is a disorder of the autonomic nervous system resulting in respiratory dysregulation. The clinical outcome is typically poor, with few individuals living into adulthood and even fewer surviving to adulthood with normal neurological function. Our patient initially presented following an uncomplicated delivery with hypotonia, poor respiratory effort, and hypoxemia that required ventilatory support. ⋯ Close long-term management and appropriate treatment modifications have provided for an excellent outcome and good quality of life. The patient is currently 22 years old and is earning her teaching degree for K-12 art education. A combination of early recognition and a multidisciplinary approach may lead to a successful outcome in patients with CCAH syndrome.
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Clinical pediatrics · Nov 2008
Clues that aid in the diagnosis of nonaccidental trauma presenting as an apparent life-threatening event.
Apparent life-threatening events (ALTEs) can encompass many different diagnoses. Nonaccidental trauma (NAT) is one potential serious diagnosis. ⋯ NAT should be considered when an infant is admitted for evaluation of an ALTE.
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Clinical pediatrics · Nov 2008
Initial fluid resuscitation for patients with diabetic ketoacidosis: how dry are they?
A prospective consecutive case series of patients aged 5 to 20 years who presented to a pediatric emergency department with diabetic ketoacidosis (DKA) was studied to determine the actual percent loss of body weight during an episode of DKA to determine the degree of dehydration and thereby provide a guide for hydration therapy during such an episode. Patients' weights at the time of presentation, inpatient discharge, and at the first follow-up clinic visit were used to calculate the percent loss of body weight. ⋯ Clinical assessment was a poor predictor of severity of dehydration and overestimated the percent dehydration in 67% of patients. Based on these data it is recommend that initial fluid therapy for DKA should assume moderate dehydration with adjustment made according to clinical response.
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Clinical pediatrics · Nov 2008
Necessity of routine pelvic radiograph in the pediatric blunt trauma patient.
Pelvic radiographs are obtained frequently in pediatric blunt trauma. The authors hypothesize that there are clinical indicators that can predict pelvic fracture on a pelvic radiograph in the pediatric blunt trauma patient with a Glasgow Coma Scale score of 14 or 15. ⋯ Clinical indicators may be useful in determining the need for pelvic radiographs in awake and alert pediatric blunt trauma patients.