Riad Lutfi

Plasmapheresis to Treat Hypertriglyceridemia in a Child With Diabetic Ketoacidosis and Pancreatitis

A 10-year-old girl presented with diabetic ketoacidosis, shock, and severe abdominal pain. She was found to have acute pancreatitis and acute kidney injury after shock resuscitation and severe persistent hypertriglyceridemia. The severe hypertriglyceridemia was treated with 1 course of plasmapheresis, which corrected the triglyceride level and was temporally associated with improvement of the abdominal pain and renal dysfunction. Diabetes is known to contribute to an elevated triglyceride level, especially in the setting of an underlying lipid disorder. However, no such disorders were found in this patient. To the best of our knowledge, this is the first report of a pediatric patient presenting with the triad of severe hypertriglyceridemia, diabetic ketoacidosis, and pancreatitis treated successfully with plasmapheresis.

Thiamine Deficiency Leading to Refractory Lactic Acidosis in a Pediatric Patient

Thiamine plays a critical role in energy metabolism. Critically ill children and adults may develop thiamine deficiency with ultimately increased mortality due to potentially irreversible consequences of severe type B lactic acidosis. We report a case of an unvaccinated term neonate with malignant pertussis requiring extracorporeal membrane oxygenation and continuous renal replacement therapy, who developed profound lactic acidosis of unknown etiology. After countless evaluations for likely causes, the patient was ultimately determined to have thiamine deficiency and her acidosis resolved rapidly with vitamin supplementation.

Devastating Ischemic Stroke Following Selective Arterial Embolization of a Large Chest Wall Aneurysmal Bone Cyst.

Aneurysmal bone cysts (ABC) are benign bone lesions found in children and young adults. Rarely, these lesions can arise from ribs, and there is disagreement on the best treatment because of proximity to vital structures. Frequently, surgeons remove ABC with en bloc resection. Selective arterial embolization has been used as an adjunct to surgery, or rarely as the primary treatment. We report a case of embolic stroke complicating embolization of a rib ABC, likely from the presence of collateral circulation between the mass and vertebral artery. Caution should be taken when performing embolization of lesions in this location because of potential complications.

1224: TARGETED TEMPERATURE MANAGEMENT REDUCES FEVER INCIDENCE IN PEDIATRIC TBI AND CARDIAC ARREST

Learning Objectives: In critically ill children who suffer from cerebral ischemia and brain trauma, elevated body temperature is common and associated with neurologic deterioration and poor outcomes. Recent studies have failed to show benefit of hypothermia over targeted normothermia (TN) in this patient population. We developed a proactive targeted temperature management protocol at our institution with the goal of maintaining normothermia in pediatric patients post-cardiac arrest or traumatic brain injury (TBI). We hypothesized that this protocol would decrease the incidence of fever in our targeted patient population. Methods: This study was conducted as a quality improvement project in a busy level 1 trauma center children’s hospital. A retrospective chart review of patients who sustained a severe TBI or cardiac arrest was conducted. We compared the incidence of fever after the implementation of our protocol to a similar control group from the two years prior to protocol implementation as part of a PDSA cycle. We collected basic patient demographics, incidence of fever within the first 72 hours of admission, PICU length of stay (LOS), hospital LOS, and in-hospital mortality. Variables were compared using Chi-squared or Mann-Whitney U test, as appropriate. Results: In the year after protocol implementation, 26 patients met criteria for TN. We used a comparison group of 47 patients from the two years prior to implementation. Patient populations were similar with regard to age, gender, and race. There was a higher proportion of TBI patients in the control group vs the TN group (66% vs 27%, p=0.001). There was a significant decrease in fever incidence in the TN group vs controls (23% vs 47%, p=0.046). There was no significant difference in any other collected outcome. Conclusions: We found that a proactive temperature management protocol decreases the incidence of fever in pediatric patients post TBI and cardiac arrest. Further PDSA cycles will need to focus on more rapid initiation of the protocol to further reduce fever incidence in this population.

168: USING SMARTPHONE TECHNOLOGY WITH INTERACTIVE SPACED EDUCATION TO ENHANCE TRAINEES’ MEDICAL EDUCATION

Introduction: Medical knowledge learned by trainees is often quickly forgotten. Spaced education theory refers to finding educational encounters that are spaced and repeated over time, compared to mass distribution of the education encounter at one setting. This results in more efficient learning an