Updates in hyponatremia and hypernatremia Saba, Leslie; Hanna, Christian; Creo, Ana L
Current opinion in pediatrics,
2024-Apr-01, 2024-04-00, 20240401, Letnik:
36, Številka:
2
Journal Article
Recenzirano
Hyponatremia and hypernatremia are commonly encountered electrolyte abnormalities that require timely and careful intervention, as they can be associated with significant morbidity and mortality.
...This review article addresses the etiology, presentation, diagnosis, and management of both hyponatremia and hypernatremia, emphasizing the latest advancements and emerging trends in pediatric care.
A methodical approach is needed to accurately assess and treat hyponatremia and hypernatremia. Both conditions continue to rely on serum and urine testing, however newer tests such as copeptin and stimulated testing may hold promise to further refine testing in the future.
Case Description: A lean, 17-year-old Caucasian male with type 1 diabetes diagnosed at age 9 experienced an abrupt increase in his insulin requirements. He was managed on mixed daily injections. ...Daily insulin requirements increased from 1.7 units/kg/day to 3.3 units/kg/day over 6 months. His total insulin level was 7 mcIU/mL with a free insulin level of 4.8 mcIU/mL, indicating exogenous insulin antibodies. Switching from insulin aspart to glulisine, due to presumed antibodies against insulin aspart was unsuccessful, and his insulin requirements continued to increase to 4.4 units/kg/day. Immunosuppressive therapy was commenced with mycophenolate mofetil, decreasing his insulin requirements to 1.1 units/kg/day after 7 months of treatment. Repeat testing revealed an improvement in the discrepancy between total and free insulin levels, with a total insulin level of 5.2 mcIU/mL and free insulin level of 4.6 mcIU/mL.
Discussion: Exogenous insulin antibody syndrome should be considered in patients with poorly controlled diabetes and requiring greater than 2 units/kg/day of insulin without obesity. Classically, antibodies against exogenous insulin were found in patients receiving insulin derived from animal sources; however, recombinant human insulin can very rarely trigger an antibody response in select patients. Immunosuppression using mycophenolate mofetil greatly reduced insulin requirements and this case highlights its novel use in children with diabetes who develop insulin antibody syndrome.
Disclosure
L. Saba: None. A. B. Orandi: None. S. Pittock: None. A. Creo: None.
Background
The Vasarhelyi method of child art psychotherapy (CAP) is offered at certain Child and Adolescent Mental Health Services. Children attend three introductory sessions, and then choose to ...continue weekly CAP or conclude the sessions.
Aims
This study aims to identify the clinical disorders and characteristics of patients referred to CAP, and to determine who engages with the therapy.
Methods
A retrospective review of the clinical records of 67 children who attended CAP in DNCC/Mater CAMHS over 13 years was performed. The data was analysed using Microsoft Excel 12.0 and SPSS version 20.
Results
67 children (57 % male and 43 % female) aged 5–17 years participated in CAP with an average age of 10.6 years. Children attended an average of 14 sessions of CAP, with a range of 1–61 sessions (mean of 13.8 ± 12.9 sessions). Anxiety disorder (28 %), behaviour disorder/ODD (25 %), and ADHD (21 %) are the most common diagnoses referred. These diagnoses along with autism spectrum disorder (ASD) had the highest overall engagement, while those with depression engaged the least. Children with ADHD and with ASD attended high numbers of sessions (with a mean of 23 and 19 respectively). Those who experienced acute life events or difficulties in the home engaged well (60 and 40 % respectively). There was no significant difference found in the percentage of appointments attended by males in comparison to females.
Conclusion
CAP is generally acceptable to children, with a high average attendance rate. It was noted that children with ADHD and with ASD engaged well with the therapy for prolonged periods, whereas children with depression did not engage so well. We suggest that CAMHS clinics should consider referring children diagnosed with ADHD and children diagnosed with ASD to CAP as an adjunct to other therapies. We suggest that individuals with depression should be referred initially to other therapeutic services as the engagement with CAP was relatively poor.
At the direction of its Board of Directors, the AMCP Public Policy and Professional Practice committees developed these principles for pay-for-performance to promote the use of these arrangements ...that lead to improved patient outcomes. This document was first released on the AMCP website on December 14, 2021.
•BREMSO is associated with cognitive and physical disability in early MS patients.•BREMSO identifies low risk patients at disease onset who will benefit from safer DMTs•SDMT associated to BREMSO ...better categorize intermediate BREMSO risk scores patients.
Prevention of long-term disability is the goal of therapeutic intervention in Relapsing Remitting MS (RRMS). The Bayesian Risk Estimate for MS at Onset (BREMSO) gives an individual risk score predicting disease evolution into Secondary Progressive MS (SPMS). We investigated whether BREMSO correlates with physical disability, cognitive dysfunction, and regional brain atrophy early in MS.
One hundred RRMS patients with at least two years of follow-up were enrolled. BREMSO score as well as Symbol Digit Modalities Test (SDMT) and Multiple Sclerosis Severity Score (MSSS), Timed 25-Foot Walk Test (T25-FW) and 9-Hole Peg Test (9-HPT), were assessed. Intracranial volume (ICV), subcortical gray matter structures and corpus callosum (CC) were automatically segmented on MRI images and their volumes measured.
BREMSO score correlated negatively with SDMT at visit1 (β = −0.33, p = 0.019), visit2 (β = −0.34, p = 0.017) and visit3 (β = −0.34, p = 0.014), and positively with MSSS at visit1 (r = 0.38, p = 0.006), visit2 (r = 0.47, p < 0.0001) and visit3 (r = 0.42, p = 0.002), but not with T25-FW and 9-HPT. BREMSO negatively correlated with CC volume at baseline (p < 0.03). No correlations were found with ICV and subcortical gray matter.
BREMSO score at onset correlated with physical disability (MSSS), cognitive function (SDMT) and CC volume measurements in patients with early MS.
Background
Clinical guidelines recommend cardioverter defibrillator implantation for patients with heart failure and reduced ejection fraction. Despite this, women and minorities have been less ...likely to receive implantable cardioverter‐defibrillator (ICD) therapy than white men. We examined race and sex differences in ICD implantation in a recent cohort.
Methods
Using cross‐sectional, retrospective analyses, we mined our health system's outpatient electronic medical records to assess age, race, sex, medications, and comorbidities for patients aged ≥18 years with ejection fraction ≤ 35% during 2014. While adjusting for confounding variables such as medications, age, and comorbidities, we conducted a multivariable logistic regression assessing whether racial and sex differences in ICD therapy persist.
Results
Among 5,156 outpatients with ejection fraction ≤35%, 1,681 (32.6%) patients had an ICD present at the time of their index outpatient visit in 2014. Women were less likely to have an ICD than men (25.0% vs 36.3%, P < 0.01), and black patients were less likely to have an ICD than white patients (28.0% vs 33.2%, P = 0.02). In adjusted multivariable analyses, women were less like to have ICDs (adjusted odds ratio OR = 0.68, 95% confidence interval CI, 0.58–0.79, P < 0.01) but the race difference dissipated (adjusted OR for black race = 0.86, 95% CI, 0.68–1.08, P = 0.18).
Conclusions
In this large, outpatient cohort, we have shown that sex differences in ICD therapy continue to exist, but the difference in ICD prevalence by race was attenuated. Dedicated studies are required to fully understand the causes of persistent sex differences in ICD therapy.
PDF
