Pediatric Annotations # 1

1. Ondine Syndrome:

a] Can present in infancy. b] Megacolon in 20 % cases. c] Eye changes

2. If you are suspecting adrenal insufficiency, may give IM hydrocortisone , if no IV access. Do not wait for IV access as time is crucial.

3. Is Ulcerative colitis curaable?

Yes, Colectomy is curative for Ulcerative colitis, but pt may develop Crohn's disease.

4. Chemotherapy: We give allopurinol with 6 MP as it has a synergistic action.

5. Chemotherapy criss-cross:

a] Ara- C: high dose may cause conjunctivitis ad fever. Chemical irritation of the eyes is treated with dexamethasone eye drops. Can also add Normal Saline eye drops.

b] L -aspariginase:Coagulopathies.

Pancreatitis: abdominal pain. Check amylase and lipase to r/o pancreatitis and abd US to r/o thrombosis. Hyperglycemia may also be seen in pancreatitis.

c] Glomerular toxicity: cisplatin, MTX d]

Ototoxic: Cisplatin

e] Pancreatitis: L- asparginase, MTX

f] Pulm fibrosis: Bleomycin

6. Dysautonomia:

To understand the concept, remember like this: a kind of disorder where there is normal brain and normal body, but the relay center is abnormal. Thus messages trying to go up and down: any abnormality can happen. Two categories: Familial/ Riley -Dey syndrome ; Non-Familial: NFD 464 is an example.

7. Kawasaki Disease:

a]Peak age: 1- 4 yrs

b] Recureence rate: 1- 3 %

c] More in asians

d] It is a Vasculitis, mainly of medium sized vessels

e] Conjunctivits:

Peri-limbic sparing

usually bilateral

non exudative

bulbar area more involved

e] sub-ungual peeling of skin is a not seen in acute phase, mainly in subacute phase.

f] coronary artery aneurysms seen by 8- 10 days of disease. coronary ectasia may be seen earlier.

Without Rx: 20 % pts will develop coronary artery aneurysms, while with Rx, it comes down to 3-4 %. Thus huge difference. Thus Rx within first 10 days has huge impact.

Risk of aneurysm is more if:

male, age 2- 9

g] Rx: aspirin + IVIG

8. Risk of Non- febrile seizures (may be epilepsy) in a pt with Febrile seizures increases:

a] Pt has complex FS

b] Family h/o non- FS

c] Pt of FS has neuro-developmental delay (like a pt of autism develops FS).

The risk of developing seizures (non-febrile) is 4 % if 1-2 risk factors; is 8 % if 3 risk factors are present.

9. Cephalosporins: Are of no use against MRSA and enterococci.

10. Etrapenem: * Can be given as q OD. ** Lesser activity against pseudomonas and acinetobacter Cf with meropenem.

11. Daptomycin: a] NOt good for pneumonia as poor lung penetration. b] Do weekly CK levels as it causes myalgias and weakness. c] Affects Prothrombin time as it reacts with prothrombin chemically. 12. Linezolid: 100 % absorbed orally.

13. a] Classically, Depakote (valproic acid) was used as a first choice for generalized seizures and carbamazepine is used for partial epilepsies. This scheme is being modified now though as more meds ae being available. b] Newer AEDs are generally used for partial seizures. Keppra and topamax ae also now being used against generalized seizures. Also remember: Dilantin and carbamazepine may worsen myoclonic seizures.

For myclonic seizures: Depakote is DOC. If no effect: benzodiazepines

14. Difference between UMN Vs LMN:

A] UMN: Example transverse myelitis

a] sensory level generally + (thus check abd , cremeasteric and anal reflexes to ascertain level).

b] Tone Increased C] DTRs brisk

B] LMN (eg: GBS)

Sensory intact, tone ldecreased an DTRs absent.

15. Myoclonic seizures:

a] First differenciate whether they are myo.sezures Vs just myclonic movements.

b] Myoclonic seizures are classified as: Benign AND progressive

1] Benign: Mycolonic seizures of infancy

Myc seizures of adolesecence (Janz)

2] Progressive:

Duarte syndome: strta durng infancy , often first Sz is febrile

Ohtohara

MERRF

MELAS

Lafora

Unverrich lundberg syndrome