James N. Etteldorf

Comparison of High-Dose and Low-Dose Insulin by Continuous Intravenous Infusion in the Treatment of Diabetic Ketoacidosis in Children

We studied the efficacy of low-dose (0.1 U/kg/h) and high-dose (1.0 U/kg/h) insulin, given randomly to children with diabetic ketoacidosis (DKA) by continuous intravenous infusion without a loading dose. Plasma glucose reached 250 mg/dl in 3.4 ± 0.4 h with the high-dose insulin group compared with 5.4 ± 0.5 h with the low-dose insulin group (P < 0.01). During the first 12 h of therapy, plasma glucose fell below 100 mg/dl in 2 of 16 in the low-dose compared with 12 of 16 in the high-dose patients. The decrement of ketone bodies, cortisol, and glucagon was similar in both groups. The number of hours required for HCO3– ≥ 15 meq/l and arterial blood pH ≥ 7.30 were not significantly different in the two groups. Hypokalemia (K < 3.4 meq/L) occurred in 3 of 16 low-dose and 10 of 16 high-dose patients. The data show that low-dose insulin, with a slower rate of glucose decrease, is as effective as a high dose for the treatment of DKA in children with less incidence of hypokalemia and decreased potential for hypoglycemia.

Cyclophosphamide in the treatment of common neoplastic diseases of childhood

Cyclophosphamide, a new alkylating agent, was administered to 59 children with neoplastic disease. Long-term continuous therapy was employed. The drug dosage was adjusted by the white blood count since depression of granulocyte production occurred at doses that have little effect on erythrocyte and thrombocyte production. Alopecia and hemorrhagic cystitis were frequent. Temporary remissions occurred in patients with lymphomas and in 6 of 16 children with acute leukemia. There was temporary regression of tumor in patients with neuroblastoma, rhabdomyosarcoma, Ewings sarcoma, and malignant teratoma. Cyclophosphamide seemed most useful for palliation or in combination with operation and/or radiation. The likelihood that cyclophosphamide alone will cure any of the diseases treated seems remote.

Second attacks of acute glomerulonephritis

The cases of 12 Negro children with two clinically and histologically similar attacks of acute glomerulonephritis are reported. The absence of clinical and histologic evidences of chronic glomerulonephritis during a period of 6 to 108 months of follow-up study is emphasized. Lobular mesangial hyperplasia constituted the major persistent histologic abnormality; focal thickening of Bowmans capsule was less frequently observed.

Salicylate intoxication in children—experience with peritoneal dialysis and alkalinization of the urine

Thirteen children with salicylate intoxication were studied. Seven patients were treated with intravenous fluids and alkali alone and six were treated with a combination of intravenous fluid and alkali and with intermittent peritoneal dialysis by means of 5 per cent albumin in an isoosmotic buffer. With full cognizance of its potential dangers, liberal amounts of sodium bicarbonate were used and no complications were encountered. As has been shown by others, sodium bicarbonate promoted renal excretion of salicylate. However, the combination approach was significantly more effective in removing salicylate from the body. The additional use of peritoneal dialysis is recommended in the treatment of those patients in whom more rapid removal of salicylate is desirable.

Methylene blue in the treatment of methemoglobinemia in premature infants caused by marking ink; a report of eight cases.

Summary Eight cases of methemoglobinemia resulting from the use of aniline-containing ink to mark diapers are reported. Prompt relief and complete recovery followed treatment with intravenous methylene blue in each case. A brief review of the literature isincluded.

Insulin and proinsulin in normal and chemical diabetic children

Plasma levels of total immunoreactive insulin and immunoreactive proinsulin were studied in 10 normal children and 15 children with chemical diabetes ranging in age from 5 to 13 years. Eleven of the children with chemical diabetes demonstrated significantly elevated TIRI during fasting and following glucose administration. There was a delay in the increment of plasma TIRI in four children with chemical diabetes, but otherwise their TIRI levels were normal. In these four children IRP was not significantly different from normal; however, in the remaining children with chemical diabetes, those with elevated TIRI, the IRP was elevated following glucose administration. Although the IRP was significantly elevated in the hyperinsulinemic group, the TIRI was also increased to such an extent that the glucose intolerance demonstrated in these patients could not be attributed to the elevated IRP.

Effect of certain nor-steroids on creatine excretion

Summary 1. Urinary creatine excretion was studied in 5 children following the administration of normethandrolone and 6 children following the administration of norethandrolone. 2. Both normethandrolone and norethandrolone induce reversible creatinuria in children. 3. Administration of normethandrolone and norethandrolone is associated with a slight increase in urinary excretion of the creatine precursor, guanidoacetic acid. 4. The mechanism of action of these compounds on creatine metabolism is possibly not identical with that of methyltestosterone and requires additional study in order to elucidate the mechanism of action.

Treatment of diarrhea with combined aureomycin and triple sulfonamides (Aureomagma)

Summary The results of employing a combination of Aureomycin and triple sulfonamides—sulfadiazine, sulfamerazine, and sulfamethazine (Aureomagma)—are reported in the treatment of diarrhea of infancy and childhood. Diarrhea was due to infections with Sh. paradysenteriae or of unknown etiology. The combination has been evaluated according to the following criteria: (1) reversal of positive stool cultures, (2) influence upon the duration and severity of diarrhea, (3) requirement for extended parenteral fluid therapy, (4) reduction of fever, (5) length of hospitalization, (6) blood sulfonamide levels, and (7) undesirable side effects. In all respects, this combination was observed to be superior to a variety of chemotherapeutic and antibiotic agents when the remainder of the treatment was similar.

ETIOLOGY AND TREATMENT OF SEVERE DIARRHEA IN INFANTS AND YOUNG CHILDREN.

Severe diarrhea in infants and young children is discussed in terms of etiology, specific drug therapy, and correction of acid- base and fluid-electrolyte imbalance. Details of initial hydration therapy and of subsequent replacement and maintenance are presented. Also included is a discussion of hypertonic dehydration, which may be associated with diarrhea and requires a special therapeutic approach.

Adrenogenital syndrome due to congenital virilizing adrenal hyperplasia

Summary A survey is made of fourteen cases of virilizing adrenal hyperplasia observed in the last ten years. The clinical and metabolic variability of the disease is emphasized. The diagnosis and management are discussed. Recent advances in the physiopathology of the disease are briefly reviewed.