İlknur Tolunay

Cerebral Salt Wasting in Status Epilepticus: Two Cases and Review of the Literature

BACKGROUND Cerebral salt wasting is a hypovolemic hyponatremia state, caused by natriuresis and diuresis. The most important element of treatment is to replace the volume and sodium loss and improve the current clinic. PATIENTS We present two children who were treated in the intensive care unit who subsequently developed cerebral salt wasting. Diagnosis was based on hyponatremia associated with high urinary sodium excretion and inappropriately high urine output in the presence of dehydration. As part of the treatment, one patient was given fluid and sodium replacement, measures that were insufficient in the other patient, who also required fludrocortisone treatment. CONCLUSION The status epilepticus may be involved in the etiology of cerebral salt wasting. In both patients, cerebral salt wasting was detected in the posttreatment follow-up evaluations. Cerebral salt wasting is particularly likely to occur in individuals with status epilepticus, and the electrolyte and hydration status of these patients should be monitored closely, even after the convulsions are taken under control.

Assessment of central venous catheterization and complications in a tertiary pediatric intensive care unit

Tolunay İ, Yıldızdaş RD, Elçi H, Alabaz D. Assessment of central venous catheterization and complications in a tertiary pediatric intensive care unit. Turk J Pediatr 2018; 60: 63-69. In catheter-using units as pediatric intensive care, it is important to know the complications that may occur during the insertion and use of central venous catheterization (CVC), and to take appropriate measures in order to reduce the mortality and morbidity of critical patients. The aim of this study was to evaluate CVC and catheter related complications in our tertiary pediatric intensive care unit. For this prospective study, 155 central venous catheters and/or hemodialysis catheters used with 106 patients, between August 2014 and August 2015 were evaluated. Demographic information about patients, catheter insertion procedure and catheter related complications were recorded. Sixty-two (58.5%) male and forty-four (41.5%) female patients were evaluated in this study. The median age was 67.5 months (1-212). The mean dwell time of catheters was 10.54±8 days. Twenty-two (14.2%) catheters were removed from patients because of catheter related complications. The mean dwell time of complicated catheters was 10.6±8.5 days and there was no statistically significant difference between complicated and non-complicated catheters. Catheter related blood stream infections was diagnosed in 5.1% (8/155) patients and these catheters were removed from patients. Including these patients, positive blood culture was found to be at 14.2% (22/155). The mean dwell time of catheters with positive blood culture was 14.25±7.3 days. The mean dwell time of catheters with positive blood culture was statistically significantly longer than catheters with negative blood culture. In the 3 patients who developed catheter thrombosis, 2 patients were followed up because of infection/sepsis and 1 patient had a neurological disease. Catheter thrombosis developed in 1 femoral vein and 2 internal jugular veins. The development of central venous catheter complications depends on many different factors and it is possible to reduce the complications with precautions taken during replacement and daily use.

Appraisal of the ″pediatric ARDS: consensus recommendations from the pediatric acute lung injury consensus conference″ with the AGREE II instrument

Background/aim: The ″Pediatric Acute Lung Injury Consensus Conference″ (PALICC) was convened in order to develop a taxonomy to define pediatric acute respiratory distress syndrome (ARDS). The Appraisal of Guidelines for Research and Evaluation (AGREE) assesses the quality of guidelines. The aim of this study is to evaluate the new pediatric ARDS guideline using the AGREE II instrument. To the best of our knowledge, this is the first assessment of the new pediatric ARDS clinical practice guideline in the English literature. Materials and methods: Four appraisers assessed the new pediatric ARDS guideline with the AGREE II instrument. At the end of the evaluation each appraiser rated the overall quality of the guidelines. Results: Results of the assessment were editorial independence 100%, clarity of presentation 94%, scope and purpose 89%, stakeholder involvement 78%, rigor of development 78%, and applicability 78%. Conclusion: The new pediatric ARDS guideline received good scores especially with respect to editorial independence and clarity of presentation. Our overall AGREE II review of the PALICC guideline indicates that it has been created using high quality methodology and should be recommended for use and implementation as currently published.

Konjenital nefrotik sendromlu bir infantta periton diyalizine bağlı olarak görülen nadir bir komplikasyon olarak şiloz asit

Şiloz asit; periton diyalizi yapilan hastalarda nadir gorulen fakat onemli bir non-enfeksiyoz komplikasyondur. Konjenial nefrotik sendromlu 1,5 aylik erkek hasta genel durumunda kotulesme, diffuz odematoz gorunum ve solunum sikintisi nedeni ile cocuk yogun bakim unitesine kabul edildi. Yatisinin ucuncu gununde periton diyaliz kateteri takilarak periton diyalizi uygulanmaya baslandi. Periton diyaliz kateteri takildiktan bes gun sonra (yatisinin sekizinci gununde) diyaliz sivisi sut gorunumu almaya basladi. Sut gorunumundeki sivinin biyokimyasal analizi siloz asit karakteri gosteriyordu: trigliserit 468 mg/dl. Şiloz asit kisa zincirli yag asitlerinden zengin dusuk lipidli diyet ve somatostatin analogu (octreotid) infuzyonu ile tedavinin 5. gununde duzeldi ve hasta tedavinin devami icin pediatri servisine transfer edildi.

Urolithiasis Frequency and Risk Factors in Home Ventilated Patients with Tracheostomy

©Telif Hakkı 2017 Çocuk Acil Tıp ve Yoğun Bakım Derneği Çocuk Acil ve Yoğun Bakım Dergisi, Galenos Yayınevi tarafından basılmıştır. Yazışma Adresi/Address for Correspondence: Dr. İlknur Tolunay, Çukurova Üniversitesi Tıp Fakültesi, Çocuk Yoğun Bakım Bilim Dalı, Adana, Türkiye E-posta: ilknurtolunay@gmail.com ORCID ID: orcid.org/0000-0002-3454-8483 Geliş Tarihi/Received: 30.07.2017 Kabul Tarihi/Accepted: 14.09.2017 Giriş: Bu çalışmada, ev tipi ventilatör ile izlenen trakeostomili hastalarda ürolitiazis sıklığı ve risk faktörlerinin değerlendirilmesi amaçlanmıştır. Yöntemler: Ocak 2014 ve Aralık 2015 tarihleri arasında çocuk yoğun bakım ünitemize yatırılan ve ev tipi ventilatörü olan trakeostomili 30 hasta geriye dönük olarak değerlendirilmiştir. Hastalara ait yaş, cinsiyet, altta yatan hastalık, kullanmakta olduğu ilaçlar, beslenme şekli, beslenme ürünü, kan biyokimyası, parathormon, 25(OH) vitamin D düzeyi, spot idrarda kalsiyum/kreatin, üriner sistem ultrasonografisi bilgileri hastaların arşiv dosyaları ve bilgisayar sisteminden elde edilmiştir. Bulgular: Hastaların %30’u (9/30) kız, %70’i (21/30) erkek olup yaş ortanca 70 ay (15-197 ay) idi. Motor fonksiyon sınıflama sistemine göre hastaların %33,3’ü (10/30) skor 4, %66,7’si (20/30) skor 5 olup tamamı immobil hastalar idi. Üriner sistem ultrasonografisi ile hastaların %30’unda (9/30) üst üriner sistem taşı saptandı. Hastaların %56,7’sinde (17/30) spot idrar kalsiyum/kreatin 0,21’in üzerinde bulundu. Yaşa göre spot idrar kalsiyum/kreatin hastaların %66,6’sında (20/30) yüksek saptandı. Hastaların günlük kalsiyum alımı 541±182 (336-1200) mg/gün; vitamin D alımı 25,9±10,6 (7,8-51,4) μg/gün idi. Hastaların tamamında kan kalsiyum düzeyi normal sınırlarda (8,5-10,5 mg/dL) olup kan 25(OH) vitamin D düzeyi 8 hastada >30 ng/mL, 13 hastada 20-30 ng/mL ve 9 hastada <20 ng/mL idi. Sonuç: Ev tipi ventilatör ile izlenen trakeostomili hastalarda immobilizasyon ürolitiazis açısından önemli bir risk faktörü olup bu hastaların eşlik eden metabolik bozukluklar açısından düzenli olarak takip edilmesi gerekmektedir. Anahtar Kelimeler: Çocuk, immobilizasyon, ürolitiazis, ev tipi ventilatör hastas

Intravenous levetiracetam in critically ill children.

Background: To report the effectiveness and safety of intravenous (IV) levetiracetam (LEV) in the treatment of critically ill children with acute repetitive seizures and status epilepticus (SE) in a children′s hospital. Materials and Methods: We retrospectively analyzed data from children treated with IV LEV. Results: The mean age of the 108 children was 69.39 ± 46.14 months (1-192 months). There were 58 (53.1%) males and 50 (46.8%) females. LEV load dose was 28.33 ± 4.60 mg/kg/dose (10-40 mg/kg). Out of these 108 patients, LEV terminated seizures in 79 (73.1%). No serious adverse effects were observed but agitation and aggression were developed in two patients, and mild erythematous rash and urticaria developed in one patient. Conclusion: Antiepileptic treatment of critically ill children with IV LEV seems to be effective and safe. Further study is needed to elucidate the role of IV LEV in critically ill children.