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Biomedical subjects

F M Henretig

Publications and source records attributed to F M Henretig.

33 records · Page 2Linked to original sources
PubMed1990

Clonidine poisoning in young children.

We reviewed 47 consecutive inpatient records to determine the clinical course, role of supportive measures, and response to naloxone in children with clonidine poisoning. Severity of illness was assigned by means of the "pediatric risk of mortality" (PRISM) score. The children's ages ranged from 9 to 84 months. Central nervous system effects were noted in 44 patients; bradycardia occurred in 25, and apnea or depressed respiration was seen in 18. Thirty-four patients had symptoms within 1 hour of presentation, but no patient had further clinical deterioration more than 4 hours after presentation. Six patients required endotracheal intubation and mechanical ventilation. There was no difference in PRISM score or duration of symptoms between those patients who received naloxone and those who did not. More patients receiving naloxone required intubation, and only three patients had definite improvement after naloxone administration. We conclude that (1) young children who ingest clonidine have a wide spectrum of serious findings, (2) delayed progression of symptoms after clonidine poisoning is unlikely in a young child with normal renal function, and (3) naloxone is an inconsistent antidote for clonidine poisoning.

Atropine↗
PubMed1989

The treatment of pain in the emergency department.

Our approach to the management of fear and pain in the pediatric emergency department is presented. Tricks to attempt the gaining of rapport with frightened children in pain are noted, with emphasis on a developmental approach. The use of analgesic medications, local anesthetics, ketamine, and nitrous oxide as appropriate to emergency situations is outlined. Lastly, the guidelines of the American Academy of Pediatrics for outpatient sedation are reviewed.

Analgesics↗
PubMed1988

Interpretation of color change in blood with varying degree of methemoglobinemia.

The ability to detect the characteristic "chocolate" brown color of methemoglobin containing blood was tested in a double blind study. We prepared three concentrations of methemoglobin by adding sodium nitrite to 1-2 ml of venous, heparinized blood that was "arterialized" by mixing with room air in vacutainer tubes. House officers (HO) were asked, in a standardized protocol, to make observations ("chocolate", "abnormal" or "normal") about the methemoglobin blood alone (first in Vacutainer, and then on filter paper), and then in comparison with control blood, again in Vacutainer, then filter paper. Each HO assessed only one methemoglobin concentration. Three methemoglobin blood samples were studied with 12-14%, 26-35% and 68% methemoglobin concentrations respectively. We found that the ability to detect visually an abnormal appearance of methemoglobin was significantly improved when the test sample was compared to control blood. The descriptive term "darker than normal" was much more commonly used than "chocolate" to describe the methemoglobin blood.

Blood Specimen Collection↗
PubMed1988

Pediatric chest pain: a prospective study.

Previous studies of childhood chest pain have been retrospective or considered only limited age groups or referred patients. In this study, all children who were admitted to the emergency department with chest pain were evaluated prospectively. Patients with ill-defined chest pain had ECGs and echocardiograms performed. A total of 407 children were evaluated. The most common causes of the pain were idiopathic (21%) and musculoskeletal (15%). Cardiac problems were found in 4%. Chest pain was acute (of less than 48 hours' duration) in 43% and chronic (of greater than 6 months' duration) in 7%. Pain caused 30% of children to stay out of school and 31% to awaken from sleep. Chest wall tenderness was the most common abnormality. ECGs were obtained in 47%; results of 31/191 were abnormal but only 4/191 ECG abnormalities were related to the diagnosis. Echocardiograms were obtained in 34%; results of 17/139 were abnormal (12/139 showed mitral valve prolapse). Young children are more likely to have cardiorespiratory problems; children older than 12 years of age are more likely to have psychogenic pain. The description and location of the pain and the patient's sex are not related to the diagnosis. Nonorganic disease is related to a family history of heart disease or chest pain or having chronic pain. Organic disease is related to pain of acute onset, abnormal physical examination results, pain that awakens the child from sleep, and the presence of fever. Laboratory tests are rarely helpful in evaluating children with chest pain. Chest pain in children is usually benign. Psychogenic pain and idiopathic pain are less common than previously believed.

Acute Disease↗
PubMed1986

Acute pediatric digoxin ingestion. A ten-year experience.

A retrospective study conducted in three major pediatric teaching hospitals revealed only 41 cases of acute digoxin ingestion with well-documented serum concentrations. All patients who were symptomatic at presentation (27%) had digoxin concentrations greater than 2 ng/mL (2.6 nmol/L). Only one patient had a transient elevation of the serum potassium concentration. Electrocardiographic (ECG) abnormalities (bradycardia, 1 degree or 2 degrees atrioventricular block, and ST depression) were present in 11 patients. Seven of the 11 patients had ECG abnormalities delayed more than five hours after ingestion. None of these ECG abnormalities were life-threatening. Serum digoxin concentrations ranged from 0.2 to 11.6 ng/mL (0.3 to 14.9 nmol/L). Serum half-lives were rapid (approximately three hours) in an initial phase and longer (approximately 20 hours) in a second phase. Our findings were as follows: acute pediatric digoxin ingestions are not common and are usually not severe; signs and symptoms on presentation predict a digoxin concentration greater than 2 ng/mL (2.6 nmol/L); a correlation between serum potassium and digoxin concentrations was not observed; non-life-threatening bradycardia and conduction disturbances were noted; and a serum digoxin concentration greater than 2 ng/mL (2.6 nmol/L) in the absence of signs or symptoms or ECG abnormalities soon after ingestion does not accurately predict their occurrence later in the course.

Adolescent↗
PubMed1985

Lead encephalopathy. A case report and review of management.

Acute lead encephalopathy has become a rare syndrome in the United States. Early recognition of the disease, with institution of specific chelation therapy, is critical in order to minimize mortality and morbidity. Lead intoxication, however, may mimic other more common diseases. We report an 8-year-old child with known sickle cell anemia who presented initially with findings suggestive of vaso-occlusive crisis but who deteriorated rapidly and was found to have severe lead poisoning. We present her hospital course and review the management of lead encephalopathy in detail.

Anemia, Sickle Cell↗
PubMed1984

Acute iron poisoning in children.

Acute accidental iron poisoning is a common serious and potentially fatal intoxication in the young child. Approximately 1 per cent of such poisoning have a fatal outcome, and outcome is closely related to the early onset of coma or shock. Long-term prognosis is excellent for all survivors of the acute episode, although there are occasional obstructive complications occurring four to six weeks later.

Cardiovascular Diseases↗
PubMed1984

Acute iron poisoning in children.

Acute accidental iron poisoning is a common serious and potentially fatal intoxication in the young child. Approximately 1 per cent of such poisonings have a fatal outcome, and outcome is closely related to the early onset of coma or shock. Long-term prognosis is excellent for all survivors of the acute episode, although there are occasional obstructive complications occurring four to six weeks later.

Acute Disease↗
PubMed1983

Severe iron poisoning treated with enteral and intravenous deferoxamine.

An 18-month-old boy ingested approximately 18 g FeSO4, equivalent to 336 mg/kg elemental Fe. He rapidly developed severe gastroenteric symptoms, obtundation, and transient hypotension. The serum iron level two hours after ingestion was 6,798 micrograms/dL. He was treated with deferoxamine intravenously, enterally, and as a lavage solution. His hospital course was notable for lack of severe neurologic, hepatic, metabolic, or cardiovascular complications acutely with apparent complete recovery, although he returned six weeks after ingestion with intestinal obstruction due to a jejunal stricture.

Deferoxamine↗
PubMed1983

Nasopharyngeal flora and acute otitis media.

A semiquantitative nasopharyngeal culture was found to be sensitive and specific in predicting middle ear pathogens in children with acute bacterial otitis media. In nasopharyngeal specimens with growth of at least 1,000 colonies, the tympanocentesis isolate was present and was either the predominant isolate or accounted for 50% of growth in 16 of 16 children. Data suggest that virulence of nasopharyngeal organisms plays a role in the pathogenesis of acute otitis media. Qualitative differences were found in the nasopharyngeal flora of children with bacterial otitis media as compared with children with clinical otitis media and sterile tympanocentesis cultures, children with uncomplicated upper respiratory illness, and healthy children. Abundant growth of Haemophilus influenzae (greater than or equal to 50% total colony count) was associated with children with bacterial otitis media, and abundant Branhamella catarrhalis was associated with the others (P less than or equal to 0.01). Abundant growth of Streptococcus pneumoniae occurred frequently and regardless of clinical category. Antibiotic treatment of children with otitis media resulted in rapid quantitative and qualitative changes in nasopharyngeal flora.

Acute Disease↗
PubMedDate not supplied

The effect of blood lead on blood pressure in children.

The effect of elevated blood lead levels on the blood pressure of children has not been clearly described. In order to define this association better, we conducted a cross-sectional study, evaluating the association between lead and high blood pressure. Using a Dinamap monitor to measure blood pressures, blood pressures and blood lead levels were measured in 149 children (ages 1-10 years) receiving medical care at the General Medical and Lead Poisoning Clinics at Children's Hospital of Philadelphia. Blood lead levels ranged from 7 to 70 mg/dL with a mean of 27 mg/dL. The mean systolic blood pressure was 108 mmHg and the mean diastolic reading was 63 mmHg. Higher systolic blood pressure was significantly correlated with increased weight, age, and height. Diastolic pressure was significantly associated with weight and height. There was a small, negative correlation between blood lead levels and systolic blood pressure, and a positive but insignificant correlation between lead levels and diastolic blood pressure. Our study population had both higher mean lead levels and a higher prevalence of hypertension than is true of the U.S. population as a whole. We concluded that elevated blood lead levels are not associated with elevated blood pressure in children.

Blood Pressure↗