PubMed · 14049177
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M H CHARLTON. 1963. VISUAL HALLUCINATIONS.. https://doi.org/10.1007/bf01617747
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Dysnatremias are among the most common electrolyte abnormalities encountered in hospitalized patients. In most cases, a dysnatremia results from improper fluid management. Dysnatremias can occasionally result in death or permanent neurological damage, a tragic complication that is usually preventable. In this manuscript, we discuss the epidemiology, pathogenesis and prevention and treatment of dysnatremias in children. We report on over 50 patients who have suffered death or neurological injury from hospital-acquired hyponatremia. The main factor contributing to hyponatremic encephalopathy in children is the routine use of hypotonic fluids in patients who have an impaired ability to excrete free-water, due to such causes as the postoperative state, volume depletion and pulmonary and central nervous system diseases. The appropriate use of 0.9% sodium chloride in parenteral fluids would likely prevent most cases of hospital-acquired hyponatremic encephalopathy. We report on 15 prospective studies in over 500 surgical patients that demonstrate that normal saline effectively prevents postoperative hyponatremia, and hypotonic fluids consistently result in a fall in serum sodium. Hyponatremic encephalopathy is a medical emergency that should be treated with hypertonic saline, and should never be managed with fluid restriction alone. Hospital-acquired hypernatremia occurs in patients who have restricted access to fluids in combination with ongoing free-water losses. Hypernatremia could largely be prevented by providing adequate free-water to patients who have ongoing free-water losses or when mild hypernatremia (Na>145 mE/l) develops. A group at high-risk for neurological damage from hypernatremia in the outpatient setting is that of the breastfed infant. Breastfed infants must be monitored closely for insufficient lactation and receive lactation support. Judicious use of infant formula supplementation may be called for until problems with lactation can be corrected.
Little emphasis has been accorded to peripheral skin temperature impairments in children with neurological disorders but attention has been paid to the significance of cold extremities (autonomic failure) for well-being and quality of life in adults stroke patients. Therefore, it seems important to investigate skin temperature in children with neurological disorder, especially when their communication is impaired. In the present study, we wanted to objectively verify any skin temperature differences between pre-school children with and without neurological disorders and also ascertain if any correlation existed between skin temperature and physical activity. Skin temperatures in 25 healthy children and 15 children with cerebral or spinal cord damages were assessed using infrared radiation. The temperatures were recorded on the palm and the dorsal surface of the hands and on the sole and dorsal surface of the feet three times at 15-minute intervals over 30min. A significant lower mean skin temperature in all measurement points was seen in non-walking children with cerebral damages compared to healthy controls. Also, the mean skin temperature was significantly lower in all foot measuring points in the children with cerebral damages that were unable to walk compared to those walking. In conclusion, as cold extremities may result in impaired well-being and hypothetically may be associated with other symptoms born by the child, further investigations of thermal dysfunction and autonomic function are of importance and treatment may be warranted.
UNLABELLED: The increase of encephalitis and meningoencephalitis in patients with dengue, diagnosed at a public hospital, Neurology State reference, we adopted systematic data collection. OBJECTIVE: The objective was to present 41 cases of neurological manifestations of dengue and to compare data with literature. METHOD: This is a descriptive study, retrospective from March to July 1997 and, prospective, from February to May 2002, analyzing damaged neurological regions and diagnostic of 41 patients. RESULTS: Involved regions were brain (5/7 cases - 71.4%, in 1997, and 20/34 cases - 58.8%, in 2002), spinal cord (2/34 cases - 5.9% in 2002) and peripheral nerves (2/7 cases - 28.6% in 1997 and 12/34 cases - 35.3% in 2002). There was no meningeal involvement. According to topography, there was encephalic and peripheral nerves diagnosis in both periods and, exclusively in 2002, spinal cord damage. Cerebral hemorrhage and acute disseminated encephalomyelitis were diagnosed for the first time, as well as hemifacial spasm worsening as possible neurological manifestation of dengue. CONCLUSION: This is the third casuistics in dengue and nervous system. Three dengue complications were diagnosed, for the first time registered on the literature.