Clinical features in toxic coma in children Stanca, Simona; Ulmeanu, Coriolan Emil; Stanca, Horia Tudor ...
Experimental and therapeutic medicine,
12/2019, Letnik:
18, Številka:
6
Journal Article
Odprti dostop
The purpose was to identify rapidly the etiology of toxic coma in children, to appreciate the severity of the coma, to detect elements of gravity based on associated clinical signs and symptoms and ...to evaluate the initial treatment. Toxic coma is a medical emergency, especially in a Pediatric Emergency Department, requiring rapid and precise evaluation. The key objectives in the evaluation and management of coma in children are: detecting severity characteristics, depth of coma, specific clinical signs and symptoms, etiological and differential diagnostic and also initializing supportive therapy and specific treatment. This is a retrospective study, where we analyzed all patients diagnosed with coma admitted to the 'Grigore Alexandrescu' Clinical Emergency Hospital for Children over a nine-year period from 2003 to 2011. We focused on toxic coma. A prospective component related to tracking certain signs and symptoms associated with toxic coma to diagnose and initiate appropriate therapy as early as possible was also included. In this nine-year study, 750 comatose patients were included. We found that toxicants represent the main cause of coma in children. There were 445 patients diagnosed with toxic coma, representing 59.3% and 305 cases of non-toxic coma, 40.7% of all coma cases presented in ER. The etiology of toxic coma in children is dominated by alcohol and abuse substances, followed by neurologic medication. Clinical manifestations were more frequent and more severe as the coma degree increases. Associating clinical manifestations in patients with altered neurologic status of toxic cause and toxicants has an important role in practice, because it helps us recognize the frequency of association of coma complications such as: aspiration syndrome, arrhythmias and seizures.
This study analyzed the neurological manifestation profiles of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across pandemic waves in pediatric patients. The study collected ...data on patients aged between 0 and 18 years, diagnosed with acute SARS-CoV-2 infection, admitted to a pediatric tertiary hospital between 1 March 2020 and 28 February 2023. This study included 1677 patients. Neurological manifestations were noted in 10% (n = 168) of patients with a median age of 3.2 years (interquartile range: 1–11.92). Neurological manifestations were significantly associated with the pandemic waves (p = 0.006) and age groups (p < 0.001). Seizures were noted in 4.2% of cases and reached an increasing frequency over time (p = 0.001), but were not associated with age groups. Febrile seizures accounted for the majority of seizures. Headache was reported in 2.6% of cases and had similar frequencies across the pandemic waves and age groups. Muscular involvement was noted in 2% of cases, reached a decreasing frequency over time (p < 0.001), and showed different frequencies among the age groups. Neurological manifestations of acute SARS-CoV-2 infection exhibit distinct patterns, depending on the pandemic wave and patient age group. The Wuhan and Omicron waves involved the nervous system more often than the other waves.
Most cases of envenomation by common European vipers (Vipera berus) have not been reported to have neurotoxic manifestations. However, these manifestations have been demonstrated in some cases of ...envenomation by subspecies of V. berus, found in the Carpathian Basin region of south-eastern Europe. Here, we report the case of a 5-year-old girl from the south of Romania who presented symptoms of neurotoxicity, as well as other systemic and local symptoms, after being bitten by an adder of the V. berus subspecies. Treatment consisted of monovalent antivenom, a corticosteroid, and prophylactic enoxaparin. Neurotoxic manifestations of envenomation as well as other local and systemic symptoms improved within 5 days of treatment. The presented case shows that venom from V. berus subspecies found in the Carpathian Basin can have neurotoxic effects. This case also confirmed the efficacy of monospecific antivenom treatment in bringing about rapid and complete remission, following envenomation.
Oral antidiabetics have become a common etiology associated with acute poisoning in children. The study shall carry out an analysis of the demographic characteristics, circumstantial characteristics ...and clinical profile associated with oral antidiabetic poisoning. An observational, descriptive and retrospective study was carried out over a period of 4 years including children confirmed with the diagnosis of acute poisoning with oral antidiabetics. In the study group, there is a prevalence of voluntary acute poisoning in female patients in the 15 to 18 year age group. bIn the group study biguanides were the most frequent pharmaceutical dugs involved. The predominant clinical manifestations associated with oral antidiabetic intoxications were gastrointestinal.
Antidiabeticele orale au devenit o etiologie frecvent asociată intoxicaţiilor acute la copil. Studiul realizează o analiză a caracteristicilor demografice, circumstanţiale şi profilului clinic ...asociat intoxicaţiilor cu antidiabetice orale. A fost realizat un studiu observaţional, descriptiv şi retrospectiv, pe o perioadă de 4 ani, în care au fost incluşi copii confirmaţi cu diagnosticul de intoxicaţie acută cu antidiabetice orale. În lotul studiat, se observă o predominanţă a cazurilor de intoxicaţii acute voluntare la pacienţii de sex feminin la grupa de vârstă 15-18 ani. Analiza etiologică a cazurilor de intoxicaţie acută în lotul studiat a identificat o predominanţă a cazurilor de expunere toxică la antidiabetice din clasa biguanide. Manifestările clinice predominante asociate intoxicaţiilor cu antidiabetice orale au fost în sfera digestivă.
Wilson’s disease is a genetic autosomal recessive transmitted pathology, that causes disorders of copper metabolism, leading to its accumulation in target tissues. It is a multisystemic affection and ...has a polymorphic clinical picture. Establishing a positive diagnosis can be difficult, with no single test that confirms or definitely excludes the disease. Diagnostic criteria for the Wilson disease in adult patients were established, then reevaluated for the child. Establishing early diagnosis allows early chelation therapy, which provides a better prognosis, delaying the progression of the disease. This is the reason why the importance of family screening must be emphasized.
Addiction is a relation of dependence, more or less alienating for an individual and more or less tolerated, sometimes even totally rejected by the individual's social environment, on a certain ...product, a certain practice or a situation. In young people addiction represents a search for sensations and a remedy for certain depression and/or anxiety symptoms. The pathology of addiction is first and foremost a pathology of sensations. The incriminated products are: tobacco and cannabis; alcohol and energy drinks associated with alcohol; new psychoactive substances (of the type of ethnobotanicals); drugs (withdrawal substances); real drugs (heroin, ecstasy); polydrug use (is quite frequent and currently includes alcohol+tobacco+ethnobotanicals+/- cannabis;). Doctors should not approach these patients alone, but together with the parents, school psychologists, school teachers, and Emergency medicine should evaluate the diagnostic modalities in intoxications with substances of abuse and psychoactive substances by taking into account: the young age of users, polyuse, repeated uses, excessive behaviours (e.g. induced alcoholic comas).
Ethanol intoxications are frequent in children, due to the ubiquitous presence of this substance and can result in serious metabolic phenomena, with important, often irreversible sequelae. Starting ...from the incidence and the severe forms of acute ethyl alcohol intoxication in children, we conducted a trial that focused on voluntary acute ethyl alcohol intoxications associated with drugs in patients hospitalized in a pediatric toxicology centre between 2005 and 2009. The association ethyl alcohol-drugs or psychoactive substances occured in 10% of the severe ethyl alcohol intoxications in teenagers, increasing the severity of intoxication, the depth of the coma and the length of hospitalization.
In children, acute liver failure (ALF) is a severe condition with high mortality. As some patients need liver transplantation (LT), it is essential to predict the fatal evolution and to refer them ...early for LT if needed. Our study aimed to evaluate the prognostic criteria and scores for assessing the outcome in children with ALF.
Data of 161 children with ALF (54.66% female, mean age 7.66 ± 6.18 years) were analyzed based on final evolution (32.91% with fatal evolution or LT) and etiology. We calculated on the first day of hospitalization the PELD score (109 children), MELD, and MELD-Na score (52 children), and King's College Criteria (KCC) for all patients. The Nazer prognostic index and Wilson index for predicting mortality were calculated for nine patients with ALF in Wilson's disease (WD).
PELD, MELD, and MELD-Na scores were significantly higher in patients with fatal evolution (21.04 ± 13.28 vs. 13.99 ± 10.07,
= 0.0023; 36.20 ± 19.51 vs. 20.08 ± 8.57,
< 0.0001; and 33.07 ± 8.29 vs. 20.08 ± 8.47,
< 0.0001, respectively). Moreover, age, bilirubin, albumin, INR, and hemoglobin significantly differed in children with fatal evolution. Function to etiology, PELD, MELD, MELD-Na, and KCC accurately predicted fatal evolution in toxic ALF (25.33 vs. 9.90,
= 0.0032; 37.29 vs. 18.79,
< 0.0001; 34.29 vs. 19.24,
= 0.0002, respectively; with positive predicting value 100%, negative predicting value 88.52%, and accuracy 89.23% for King's College criteria). The Wilson index for predicting mortality had an excellent predictive strength (100% sensibility and specificity), better than the Nazer prognostic index.
Prognostic scores may be used to predict the fatal evolution of ALF in children in correlation with other parameters or criteria. Early estimation of the outcome of ALF is essential, mainly in countries where emergency LT is problematic, as the transfer to a specialized center could be delayed, affecting survival chances.
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