Aim:To identify the clinical and biochemical risk factors associated with outcome of paracetamol induced significant hepatotoxicity in children. Methods:Retrospective case notes review of those with paracetamol overdo...Aim:To identify the clinical and biochemical risk factors associated with outcome of paracetamol induced significant hepatotoxicity in children. Methods:Retrospective case notes review of those with paracetamol overdose admitted from 1992 to 2002. Patients were analysed in two groups:group I recovered after conservative treatment and group II developed progressive liver dysfunction and were listed for liver transplantation. Results:Of 51 patients (6 males,45 females,aged 0.8-16.1 years),6 (aged < 7 years) received cumulative multiple doses,and 45 a single large overdose (median 345 mg/kg,range 91-645). The median (range) interval to hospital at presentation post-ingestion was 24 hours (4-65) and 44 hours (24-96) respectively in groups I and II. Patients received standard supportive treatment including N-acetylcysteine. All children in group I survived. In group II,6/11 underwent orthotopic liver transplantation (OLT) and 2/6 survived; 5/11 died awaiting OLT. Cerebral oedema was the main cause of death. Children who presented late to hospital for treatment and those with progressive hepatotoxicity with prothrombin time >100 seconds,hypoglycaemia,serum creatinine > 200 μmol/l,acidosis (pH<7.3),and who developed encephalopathy grade III,had a poor prognosis or died. Although hepatic transaminase levels were markedly raised in both groups,there was no correlation with necessity for liver transplantation or death. Conclusion:Accidental or incidental paracetamol overdose in children may be associated with toxic liver damage leading to fulminant liver failure. Delayed presentation and/or delay in treatment,and hepatic encephalopathy ≥grade III were significant risk factors,implying poor prognosis and need for OLT. Prompt identification of high risk patients,referral to a specialised unit for management,and consideration for liver transplantation is essential.展开更多
Background: Published formulae, frequently used to predict the volume of transfused red cells required to achieve a desired rise in haemoglobin (Hb) or haematocrit (Hct), do not appear to have been validated in clinic...Background: Published formulae, frequently used to predict the volume of transfused red cells required to achieve a desired rise in haemoglobin (Hb) or haematocrit (Hct), do not appear to have been validated in clinical practice. Aims: To examine the relation between transfusion volume and the resulting rise in Hb and Hct in critically ill children. Methods: Phase 1: Sample of 50%of children admitted during 1997; 237 of these 495 patients received at least one packed red cell transfusion; 82 children were transfused without confounding factors that could influence the Hb/Hct response to transfusion and were analysed further. Actual rise in Hb concentration or haematocrit was compared to that expected from use of existing formulae. A new formula was developed. Phase 2: In 50 children receiving a packed red cell transfusion during 2001, actual rise in Hb concentration was compared to expected rise in Hb with use of the new formula. Results: Phase 1: Existing formulae performed poorly; median ratio of actual/predicted rise in Hb or Hct ranged from 0.61 to 0.85. Using the regression coefficients new formulae were developed for both Hb and Hct. These formulae were applicable across all age and diagnostic groups. Phase 2: Median ratio of actual/predicted rise in Hb improved to 0.95 with use of the new formula. Conclusions: Existing formulae underestimate the volume of packed red cells required to achieve a target Hb or Hct. Adoption of the new formulae could reduce the number of transfusion episodes in PICU, cutting costs and reducing risk.展开更多
文摘Aim:To identify the clinical and biochemical risk factors associated with outcome of paracetamol induced significant hepatotoxicity in children. Methods:Retrospective case notes review of those with paracetamol overdose admitted from 1992 to 2002. Patients were analysed in two groups:group I recovered after conservative treatment and group II developed progressive liver dysfunction and were listed for liver transplantation. Results:Of 51 patients (6 males,45 females,aged 0.8-16.1 years),6 (aged < 7 years) received cumulative multiple doses,and 45 a single large overdose (median 345 mg/kg,range 91-645). The median (range) interval to hospital at presentation post-ingestion was 24 hours (4-65) and 44 hours (24-96) respectively in groups I and II. Patients received standard supportive treatment including N-acetylcysteine. All children in group I survived. In group II,6/11 underwent orthotopic liver transplantation (OLT) and 2/6 survived; 5/11 died awaiting OLT. Cerebral oedema was the main cause of death. Children who presented late to hospital for treatment and those with progressive hepatotoxicity with prothrombin time >100 seconds,hypoglycaemia,serum creatinine > 200 μmol/l,acidosis (pH<7.3),and who developed encephalopathy grade III,had a poor prognosis or died. Although hepatic transaminase levels were markedly raised in both groups,there was no correlation with necessity for liver transplantation or death. Conclusion:Accidental or incidental paracetamol overdose in children may be associated with toxic liver damage leading to fulminant liver failure. Delayed presentation and/or delay in treatment,and hepatic encephalopathy ≥grade III were significant risk factors,implying poor prognosis and need for OLT. Prompt identification of high risk patients,referral to a specialised unit for management,and consideration for liver transplantation is essential.
文摘Background: Published formulae, frequently used to predict the volume of transfused red cells required to achieve a desired rise in haemoglobin (Hb) or haematocrit (Hct), do not appear to have been validated in clinical practice. Aims: To examine the relation between transfusion volume and the resulting rise in Hb and Hct in critically ill children. Methods: Phase 1: Sample of 50%of children admitted during 1997; 237 of these 495 patients received at least one packed red cell transfusion; 82 children were transfused without confounding factors that could influence the Hb/Hct response to transfusion and were analysed further. Actual rise in Hb concentration or haematocrit was compared to that expected from use of existing formulae. A new formula was developed. Phase 2: In 50 children receiving a packed red cell transfusion during 2001, actual rise in Hb concentration was compared to expected rise in Hb with use of the new formula. Results: Phase 1: Existing formulae performed poorly; median ratio of actual/predicted rise in Hb or Hct ranged from 0.61 to 0.85. Using the regression coefficients new formulae were developed for both Hb and Hct. These formulae were applicable across all age and diagnostic groups. Phase 2: Median ratio of actual/predicted rise in Hb improved to 0.95 with use of the new formula. Conclusions: Existing formulae underestimate the volume of packed red cells required to achieve a target Hb or Hct. Adoption of the new formulae could reduce the number of transfusion episodes in PICU, cutting costs and reducing risk.
