RESUMEN
Eight of nine newborn infants with severe persistent pulmonary hypertension of the newborn (PPHN), and a predicted mortality of 100%, and one infant with a predicted mortality greater than 94% based on alveolar-arterial oxygen tension difference [A-a)DO2) were treated with magnesium sulphate (MgSO4) as a life saving therapy after they failed to improve with conventional treatment. Magnesium at high serum concentrations decreases pulmonary pressures and is a muscle relaxant and sedative. Diluted MgSO4.7H2O solution (200 mg/kg) was given intravenously over 20-30 minutes. No changes in the treatment were made after MgSO4. Mean serum magnesium concentration was maintained between 2.88 and 5.67 mmol/l by continuous intravenous infusion (six infants). Baseline arterial oxygen tension (PaO2) and haemoglobin oxygen saturation had mean (SD) values of 4.66 (1.8) kPa and 60.4 (29.7)% respectively, which started to increase one hour after MgSO4 infusion, and increased significantly at six hours to 12.04 (7.07) kPa and 91.8 (10.88)% respectively. Arterial carbon dioxide tension (PaCO2) decreased and pH increased significantly after one hour compared with the baseline value. PaO2 increases are probably secondary to a decrease in pulmonary vascular resistance and pressure, decrease in a right to left shunt, better ventilation:perfusion ratio, and PaCO2 decrease and pH rise. Seven infants survived (77.8%). These results demonstrate the beneficial effect of magnesium in the management of PPHN when other accepted treatment fails, is contraindicated, or not available.
Asunto(s)
Sulfato de Magnesio/uso terapéutico , Síndrome de Circulación Fetal Persistente/tratamiento farmacológico , Humanos , Concentración de Iones de Hidrógeno , Recién Nacido , Recien Nacido Prematuro , Magnesio/sangre , Oxígeno/sangre , Síndrome de Circulación Fetal Persistente/sangreRESUMEN
Seven infants with persistent neonatal hyperinsulinism were treated in Dhahran Health Centre from 1983 to 1986. The insulin:glucose ratio (serum insulin concentration pmol/l) divided by the blood glucose concentration (mmol/l) ranged from 12 to 636, mean (SD) 177 (201). To control hypoglycaemia, diazoxide (12-24 mg/kg/day) was given in a continuous intravenous glucose infusion (12-22 mg/kg/min) on 11 separate occasions, four infants twice each and three infants once each. An increase of more than one standard deviation in the heart and respiratory rates, together with other symptoms of heart failure, was considered to be evidence of diazoxide toxicity. Cardiorespiratory failure (toxicity) occurred on eight of the 11 occasions (73%) in seven infants. The average daily fluid intake, weight change, respiratory rate and heart rate before treatment were similar whether or not the infant developed toxicity. A diazoxide toxicity index was obtained by multiplying the dose of diazoxide by the insulin:glucose ratio to relate the diazoxide dose to the severity of the disease. In all instances when the toxicity index was more than 1533 (mean (SD) 3732 (2741) cardiac toxicity developed. In contrast, infants with a toxicity index of less than 675 (mean (SD) 364 (270), had no symptoms of toxicity. Symptoms were significantly related to the severity of the disease and the diazoxide dose. It is possible to use the toxicity index to predict the risk of toxicity and to calculate a safe dose of diazoxide in infants with persistent neonatal hyperinsulinism.
Asunto(s)
Diazóxido/efectos adversos , Insuficiencia Cardíaca/inducido químicamente , Hiperinsulinismo/tratamiento farmacológico , Insuficiencia Respiratoria/inducido químicamente , Glucemia/análisis , Diazóxido/uso terapéutico , Femenino , Humanos , Hiperinsulinismo/sangre , Hiperinsulinismo/complicaciones , Hipoglucemia/tratamiento farmacológico , Hipoglucemia/etiología , Lactante , Insulina/sangre , MasculinoRESUMEN
A case of histologically documented renal amyloidosis occurring in a boy who had juvenile rheumatoid arthritis is presented. The presenting problem was massive proteinuria resulting in nephrotic syndrome. Secondary amyloidosis is a serious complication of juvenile rheumatoid arthritis and it indicates very poor prognosis.
Asunto(s)
Amiloidosis/etiología , Artritis Juvenil/complicaciones , Fallo Renal Crónico/etiología , Niño , Humanos , Riñón/patología , Riñón/ultraestructura , Masculino , Microscopía Electrónica , PronósticoRESUMEN
Since its description in Japan in 1967, Kawasaki disease has been reported from several parts of the world but has been reported only once in an Arab child and never from the African continent. We report a typical case of Kawasaki disease in an Arab child in Africa who later developed coronary and several peripheral aneurysms.
Asunto(s)
Síndrome Mucocutáneo Linfonodular , Egipto , Humanos , Lactante , MasculinoRESUMEN
In a 4 1/2-year retrospective study of hospitalized patients with rheumatic fever treated with salicylates, we determined that five of 34 children manifested salicylate-induced hepatitis. The average serum salicylate level in those patients with hepatotoxicity was 30.9 mg/dL, while the average serum salicylate level in the rest of the patients was 19.7 mg/dL. An awareness of this potential complication is important when treating children with salicylates at doses previously considered to be nontoxic. Serum salicylate levels should be maintained at approximately 15 to 25 mg/dL during such therapy.