Indian journal of pediatrics
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Fever with neutropenia is a common clinical problem in patients receiving cancer treatment. Prevention and optimum management of infectious complications is critical to the overall success of cancer therapy. This article provides an overview of the current status of this evolving subject. ⋯ Oral antibiotic therapy and outpatient management are currently being studied in pediatric oncology patients, but even when successful these alternatives to the traditional "in hospital, parenteral antibiotic therapy" approach are unlikely to be applicable in all patient populations and clinical settings. While there is no replacement for clinical acumen and careful monitoring, judicious use of diagnostic resources such as blood cultures and imaging studies is a key component of optimum care. Selection of empiric antibiotics based on ongoing monitoring of antimicrobial susceptibility patterns is emphasized.
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Hyponatremia (serum sodium to < 136 mEq/l) is the most common electrolyte abnormality in critically ill children. It could result from a deficit of sodium, or surplus of water. Impaired water excretion, 'inappropriate' release of vasopressin, use of hypotonic fluids, redistribution of sodium and water, sick cell syndrome, several drugs and primary illness all may contribute to hyponatremia. ⋯ Studies addressing incidence, cause and outcome of hyponatremia in critically ill patients are needed to plan rational fluid therapy protocols, and resolve the current debate, which calls for abandonment of N/5 saline in 5% dextrose solution as maintenance intravenous fluid in favour of normal saline to prevent hyponatremia. At present it is not fully correct to assume that isotonic maintenance fluids would be superior to current maintenance fluids. Reducing the volume of maintenance fluid to about 75% of normal maintenance volume may be more appropriate way to prevent hyponatremia in view of water retaining effect of high ADH and reduced renal free water clearance in critically ill children.