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Care of the Critically Ill Pediatric Patient
Published in Praveen S. Goday, Cassandra L. S. Walia, Pediatric Nutrition for Dietitians, 2022
Katelyn Ariagno, Nilesh M. Mehta
Routine monitoring is crucial in order to assess adequacy of nutrition delivery and tolerance of nutrition interventions in the critically ill child. As the patient’s clinical status changes in the PICU, so should the nutrition plan to tailor to metabolic needs. Monitoring for unintended consequences of nutrient provision or lack thereof is essential to maximize the benefits of nutrition support therapy. The main components of such a monitoring plan include: Serial anthropometric measurementsBlood chemistry for electrolyte and glucose alterationsSigns and symptoms of intolerance to EN and/or PNAssessment for evolving micronutrient deficiencies
Neurological Diseases
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
In settings where blood chemistry tests can be carried out, electrolytes, glucose and calcium should be checked. If electrocardiography is available, it can be performed to evaluate cardiac problems in adults.
Hepatocellular Carcinoma
Published in Savio George Barreto, Shailesh V. Shrikhande, Dilemmas in Abdominal Surgery, 2020
Masakazu Yamamoto, Shun-ichi Ariizumi
The patient’s general condition, blood chemistry tests, Child-Pugh grade, and ICG-R15 are assessed before surgery. ICG-R15 is the most valuable test for evaluating liver function; however, there is some discrepancy between ICG-R15 and other blood chemistry tests which reflect liver function. If patients have abnormal ICG-R15 levels exceeding 70–80%, and normal serum albumin levels and coagulation tests, we have to consider the possibility of constitutional ICG excretory defect. Therefore, we should always check ICG-R15 and other blood chemistry tests and coagulation tests which reflect liver function. Tumor markers such as alpha fetoprotein and protein induced by vitamin K absence or antagonists-II (PIVKA-II) should be checked before surgery to consider oncological aspects. MDCT is performed to construct 3D images of the vessels in the liver. Magnetic resonance imaging (MRI) is performed to check for intrahepatic metastasis and portal vein invasion. The allowable hepatic resection is determined with a logarithmic graph based on ICG-R15. The hepatic resection volume excluding volume of tumors is measured using 3D-CT. Perioperative risks are predicted according to the novel National Clinical Database risk calculator. Anesthetists always check the patient’s preoperative condition and assess the ASA class. High-risk control meetings and cancer board meetings are held before surgery.
Gender difference in the relationship between lipid accumulation product index and pulse pressure in nondiabetic Korean adults: The Korean National Health and Nutrition Examination Survey 2013–2014
Published in Clinical and Experimental Hypertension, 2022
Hyun Ho Sung, Mi Young Gi, Ju Ae Cha, Hye Eun Cho, Ae Eun Moon, Hyun Yoon
Research subjects were classified by sex (men and women), alcohol drinking (yes or no), smoking (nonsmoker or current smoker), and regular exercise (yes or no). Alcohol drinking was indicated as “yes” for participants who had consumed at least one glass of alcohol every month over the recent year. In the smoking category, participants who smoked more than one cigarette a day and those who never smoked were classified into the current smoker and nonsmoker groups, respectively. Regular exercise was indicated as “yes” for participants who had exercised on a regular basis regardless of outdoor or indoor exercise. (Regular exercises was defined as 30 min at a time and 5 times/wk in the case of moderate exercise, such as swimming slowly, volleyball, table tennis, doubles tennis, badminton, and carrying light objects; and for 20 min at a time and 3 times/wk in the case of vigorous exercise, such as running, swimming fast, football, basketball, climbing, cycling fast, singles tennis, and carrying heavy objects). Anthropometric measurements included measurement of height, weight, body mass index (BMI), WC, SBP, and DBP. Blood chemistry included measurement of total cholesterol (TC), TGs, high density lipoprotein cholesterol (HDL-C), and fasting blood glucose (FBG). The estimated glomerular filtration rate (eGFR) was estimated from the simplified equation developed using the Chronic Kidney Disease Epidemiology Collaboration equation
Predictors of severe adverse outcomes in febrile neutropenia of pediatric oncology patients at a single institute in Thailand
Published in Pediatric Hematology and Oncology, 2020
Irene Suttitossatam, Wallee Satayasai, Phakatip Sinlapamongkolkul, Tasama Pusongchai, Paskorn Sritipsukho, Pacharapan Surapolchai
The clinical practice guideline for febrile neutropenia management in pediatric patients at Thammasat University Hospital (Supplementary Figure 1) was established in October 2013, using retrospective data and outcomes from the hospital for patients suspected of febrile neutropenia. Triage is performed by experienced nurses, and patients are categorized as stable or unstable. Stable patients are examined within 30 minutes, and unstable patients are examined immediately by pediatric or emergency medicine residents/interns. Unstable conditions include temperature > 40 °C, alteration of consciousness, rapid heart rate, or hypotension. Complete blood counts (CBC), blood chemistry, and blood culture via catheter lumens and peripheral line are done for all patients. Intravenous antimicrobial treatment is given after blood culture: first line being ceftazidime 150 mg/kg/day every 8 hours and amikacin 20 mg/kg/day once daily, or piperacillin and tazobactam 400 mg/kg/day every 6-8 hours. Second line is imipenem or meropenem 80-100 mg/kg/day every 8 hours. Door-to-antibiotic time is within 120 minutes,4 and patients are subsequently admitted to pediatric wards for further management.
Long-term effectiveness and safety of canakinumab in pediatric familial Mediterranean fever patients
Published in Modern Rheumatology, 2020
Nesrin Gülez, Balahan Makay, Betül Sözeri
Unresponsiveness to colchicine was described as having at least one attack per month for three consecutive months and elevated at least one acute phase reactant in-between attacks, despite taking maximum dose of colchicine for at least 3 months [8]. Maximum dose of colchicine was 2 mg/day for adolescents and the maximum tolerated dose for younger children [8]. Patients were asked if they regularly used colchicine as prescribed and defined as ‘compliant’ if they took the recommended doses. All the patients were compliant to colchicine treatment according to their own and/or parent’s statement. Serum amyloid A and CRP levels and erythrocyte sedimentation rate (ESR) were used to monitor the inflammation. The normal ranges were 0–6.8 mg/L for SAA, 0–0.5 mg/dl for CRP and 0–20 mm/hour for ESR. Laboratory tests including complete blood count and blood chemistry, consisting of liver and renal function tests were also evaluated.