11/235. Early onset of hypernatraemic dehydration and fever in exclusively breast-fed infants. Five cases of moderately severe hypernatraemic dehydration were identified within a 5-month period between two regional hospitals in hong kong. Unlike previous reported cases, these exclusively breast-fed infants presented with the unusual triad of fever, absence of overt signs of dehydration and within the first week of life. Three of the cases also had high serum bilirubin concentrations at presentation. The fever subsided quickly and the serum bilirubin concentration fell rapidly within a few hours of rehydration. All infants made an uneventful recovery without permanent neurological sequelae. fever, presumably secondary to dehydration, is an useful early warning sign. These cases emphasize the importance of early and regular measurement of bodyweight in exclusively breast-fed infants so that prompt identification of affected cases may prevent potentially detrimental complications. ( info) |
12/235. The intravenous use of coconut water. Medical resources routinely used for intravenous hydration and resuscitation of critically ill patients may be limited in remote regions of the world. When faced with these shortages, physicians have had to improvise with the available resources, or simply do without. We report the successful use of coconut water as a short-term intravenous hydration fluid for a Solomon Island patient, a laboratory analysis of the local coconuts, and a review of previously documented intravenous coconut use. ( info) |
13/235. Risks of intravenous administration of hypotonic fluids for pediatric patients in ED and prehospital settings: let's remove the handle from the pump. Fluid resuscitation of infants and children is a common management problem in prehospital and emergency department care. We present two cases of children who received 5% dextrose in water as the initial resuscitation fluid. Bolus administration of hypotonic fluid contributed to fatal outcomes in these cases. Recommendations are made for eliminating hypotonic fluids as stock items in both the prehospital and emergency department settings. ( info) |
14/235. Cranial MRI in neonatal hypernatraemic dehydration. Severe neonatal hypernatraemia is a life-threatening electrolyte disorder because of its neurological complications. These are brain oedema, intracranial haemorrhages, haemorrhagic infarcts and thromboses. There are few reports concerning the radiological findings in the central nervous system in severe neonatal hypernatraemia. Cranial MRI findings in hypernatraemia have been reported in an older child, but have not been described in newborn infants. We report the cranial MRI findings in a newborn infant with acute renal failure and severe hypernatraemia. ( info) |
| diabetic ketoacidosis (DKA) can result in neuropathic abnormalities of the somatic and the autonomous nervous systems. We report the case of a 50-year-old man with Type 1 diabetes of 20-year duration who after severe DKA lost vision in his right eye and only retain partial vision in his left. This case demonstrates that optic neural tissue is vulnerable to haemodynamic and metabolic complications of DKA. ( info) |
| A 7-month-old infant presented to the emergency department with diarrhea, vomiting, and decreased activity. The infant was febrile, tachycardic, tachypneic, lethargic, and had a prolonged capillary refill. Initial serum sodium was 197 mmol/L. Ultimately, the infant was diagnosed with central diabetes insipidus complicated by severe dehydration secondary to rotavirus infection. A brief review of infant hypernatremia and its evaluation and treatment in the emergency department follows. ( info) |
17/235. Hypernatraemia in early infancy. Hypernatraemia, defined as serum sodium > 150 mmol/l, is still seen frequently in tropical environments. We describe two infants, one with poor fluid intake and excessive wrapping and the other with a high solute intake, both of whom presented in a state of severe hypernatraemia. The pathophysiology of this condition is outlined, as are the major causes, such as sodium overload, inadequate water intake, increased water loss of non-renal origin, increased water loss of renal origin and essential hypernatraemia. The literature is reviewed and the current basis for management is appraised and discussed. ( info) |
18/235. Hyponatremic hypertensive syndrome. We report on a 4-year-old girl with hyponatremic-hypertensive syndrome (HHS), a rare entity in childhood. The girl was referred to us from a local hospital with a history of recurrent fever, vomiting, and seizures. On admission she was markedly dehydrated. Initial investigations revealed severe hyponatremia (serum Na 120 mmol/l), hypochloremia (serum Cl 68 mmol/l), and mild hypokalemia (serum K 3.3 mmol/l), while serum calcium and magnesium were normal. Serum urea was 5 mmol/l and serum creatinine was 62 mumol/l. Despite hyponatremic dehydration, her urine output was high (2050 ml/24 h), as was her urinary sodium (168 mmol/24 h). She had massive transient proteinuria (maximal 1642 mg/24 h) while being severely hypertensive (blood pressure 210/160 mmHg). Further investigations revealed right kidney scarring, hyper-reflexive bladder dysfunction, massive brain infarcts, and myocardial left ventricular hypertrophy. Renal arteries were normal on arteriography. blood pressure control resulted in normalization of serum and urinary electrolytes and decrease of proteinuria. hyponatremia and transient massive proteinuria in this patient seem to be caused by high-pressure-forced diuresis due to malignant renoparenchymal hypertension. ( info) |
19/235. Recurrent hyperosmolar nonketotic episodes in a young diabetic. A 15-month-old girl was successfully treated for substantial hyperosmolarity in the absence of ketosis at the onset of permanent insulin-requiring diabetes mellitus. hypotonic solutions containing small amounts of glucose and subcutaneous administration of low doses of insulin were empolyed. potassium was added to the hydrating solutions during the second hour of treatment. In the next three months, two recurrences of this syndrome were verified and successfully treated in a similar manner. ( info) |
20/235. Gastrointestinal complications in a patient with eating disorders. eating disorders are frequently observed in young people. They can induce major complications involving several organs, either directly or through protein energy malnutrition. Gastrointestinal problems are the most common and somewhat different in restrictive and bulimic anorexia. Delayed gastric emptying prevails in restrictive anorexia, with slower intestinal transit and atrophy of the smooth muscles of the gastrointestinal tract. In bulimic anorexia, vomiting is the cause of several oesophageal and gastric lesions, from oesophagitis to perforation of the oesophagus or stomach. C.G. is a 16-year old boy who weighs 41.8 kg, is 174 cm tall and has a BMI 13.7 (kg/m2). At 14 he started to suffer from restrictive anorexia, then bulimic anorexia for the last two months. The day before admission, the patient ate a large quantity of "sfoglia-telle" in about 2 hours during a bulimic crisis. After 8 hours, he had spontaneous vomiting, malaise, abdominal tension and slight mental confusion. physical examination showed a tense and tender abdomen with infrequent peristalsis, mental confusion and dehydration. Laboratory evaluation confirmed dehydration (serum albumin 5.7 g/dL); a plain abdomen film showed marked gastrectasia. Instrumental examinations (abdominal CT scan, upper endoscopy) confirmed the diagnosis of gastrectasia with tight pyloric stenosis. ( info) |