Asunto(s)
Asma , Deficiencia de Vitamina D , Asma/tratamiento farmacológico , Asma/epidemiología , Niño , Suplementos Dietéticos , Estudios de Seguimiento , Humanos , Incidencia , Vitamina D/uso terapéutico , Deficiencia de Vitamina D/tratamiento farmacológico , Deficiencia de Vitamina D/epidemiología , Deficiencia de Vitamina D/prevención & control , Vitaminas/uso terapéuticoAsunto(s)
Vitamina D , Vitaminas , Niño , Suplementos Dietéticos , Femenino , Humanos , Embarazo , Vitaminas/uso terapéuticoRESUMEN
A 13-year-old girl presented to the emergency department with acute onset of chest pain, nausea and tremor. The patient denied drug ingestion, and urine toxicology was negative. ECG demonstrated sinus tachycardia, prolonged QTc (541 ms) and ST depression. Laboratory testing demonstrated metabolic acidosis, hypokalaemia, hypophosphataemia and hyperglycaemia. She was commenced on continuous cardiac monitoring and treated with intravenous fluids and electrolyte replacement. Presenting features and laboratory abnormalities resolved within 48 hours. The National Poisons Information Service and Clinical Biochemistry were integral to her management, advising the clinical team on the likeliest aetiology. Five weeks after discharge, urine toxicology, using mass spectrometry, identified clenbuterol. Clenbuterol is an oral ß2-agonist with anabolic and lipolytic effects that is misused as a performance and image enhancing drug. Clinicians must be aware of the increasing availability of these drugs and their potential for causing harm in children and adolescents.
Asunto(s)
Acidosis/inducido químicamente , Agonistas Adrenérgicos beta/toxicidad , Clenbuterol/toxicidad , Taquicardia Sinusal/inducido químicamente , Acidosis/terapia , Adolescente , Agonistas Adrenérgicos beta/orina , Dolor en el Pecho/diagnóstico , Dolor en el Pecho/etiología , Clenbuterol/orina , Diagnóstico Diferencial , Electrocardiografía/métodos , Servicio de Urgencia en Hospital , Femenino , Humanos , Hiperglucemia/inducido químicamente , Hipopotasemia/inducido químicamente , Hipofosfatemia/inducido químicamente , Náusea/diagnóstico , Náusea/etiología , Taquicardia Sinusal/fisiopatología , Resultado del Tratamiento , Temblor/diagnóstico , Temblor/etiologíaRESUMEN
BACKGROUND & AIMS: Unrecognized nutritional issues may delay recovery in hospitalized infants. It has been proposed that nutritional risk screening should be performed at hospital admission, but few tools include infants. The aim of this study was to develop and test a tool to identify sick infants in need of dietetic input. METHODS: Hospitalised infants were recruited from hospitals in the United Kingdom (UK), Greece and Iran. Weight, skinfold thickness and mid upper arm circumference (MUAC) were measured, with detailed dietetic assessment in the UK and Greece. Simple screening questions were used in the UK cohort to formulate a score (infant early nutrition warning score-iNEWS) which was then validated in the Greek and Iranian groups. RESULTS: After dietetic assessment, 20 (9.6%) UK and 22 (22%) Greek infants were rated as needing dietetic input. Underweight, poor weight gain/loss and reduced intake were all independent predictors of perceived need for dietetic input in stepwise multivariate regression analysis. The score based on these items (iNEWS), had 84% sensitivity, 91% specificity and 49% positive predictive value to predict need for dietetic input in the UK cohort. In the Greek cohort this was 86%, 78% and 53% respectively. In all three countries, infants with high iNEWS had significantly lower average skinfold thickness (between -1 and -1.8 SD, p < 0.0001) and MUAC (between -1.8 and -2 SD, p < 0.0001) than those at low risk. CONCLUSIONS: iNEWS, a simple nutritional risk tool, identifies most hospitalised infants who need dietetic input. CLINICAL TRIAL REGISTRATION: https://clinicaltrials.gov/ct2/show/NCT03323957.