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Hughes K, Buenger L. Select topics in the management of critically ill children. Am J Health Syst Pharm 2020; 76:1532-1543. [PMID: 31532504 DOI: 10.1093/ajhp/zxz167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
PURPOSE The purpose of this review article is to discuss considerations for the critically ill child presenting to an emergency department (ED) with pharmacists who have minimal to no pediatric training. SUMMARY In 2015, 17% of all children visited an ED, constituting 30 million visits. The majority of these children were treated at community hospitals where pediatric care resources, including a pediatric-trained pharmacist, may be limited. Because of the complex array of ages and disease states, the care of critically ill children in the ED creates many concerns for adult and community hospitals. This article will focus on several common disease states seen in the pediatric ED, including septic shock, trauma, status epilepticus, and diabetic ketoacidosis. CONCLUSION Critically ill children admitted to a community or adult ED provide therapeutic dilemmas and medication safety concerns. A pharmacist with training or experience in pediatrics can have a major impact in patient outcomes in many of the disease states seen in these pediatric patients. This article highlights several key differences between critically ill pediatric and adult patients to better prepare all pharmacists to care for these vulnerable patients.
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Affiliation(s)
- Kaitlin Hughes
- Riley Hospital for Children, Indiana University Health, Indianapolis, IN
| | - Lauren Buenger
- Riley Hospital for Children, Indiana University Health, Indianapolis, IN
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Tan X, Tu Z, Han W, Song X, Cheng L, Chen H, Tu S, Li P, Liu W, Jiang L. Anticonvulsant and Neuroprotective Effects of Dexmedetomidine on Pilocarpine-Induced Status Epilepticus in Rats Using a Metabolomics Approach. Med Sci Monit 2019; 25:2066-2078. [PMID: 30892279 PMCID: PMC6437718 DOI: 10.12659/msm.912283] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Status epilepticus (SE) is the most extreme form of seizure. It is a medical and neurological emergency that requires prompt and appropriate treatment and early neuroprotection. Dexmedetomidine (DEX) is mainly used for its sedative, analgesic, anxiolytic, and neuroprotective effects with light respiratory depression. The purpose of this study was to comprehensively analyze the metabolic events associated with anticonvulsion and neuroprotection of DEX on pilocarpine-induced status epilepticus rats by LC-MS/MS-based on metabolomics methods combined with histopathology. Material/Methods In this research, rats were divided into 3 groups: a normal group, an SE group, and an SE+DEX group. Hippocampus of rats from each group were collected for further LC-MS/MS-based metabolomic analysis. We collected brains for HE staining and Nissl staining. Multivariate analysis and KEGG enrichment analysis were performed. Results Results of metabolic profiles of the hippocampus tissues of rats proved that dexmedetomidine relieved rats suffering from the status epilepticus by restoring the damaged neuromodulatory metabolism and neurotransmitters, reducing the disturbance in energy, improving oxidative stress, and alleviating nucleic acid metabolism and amino acid in pilocarpine-induced status epilepticus rats. Conclusions This integral metabolomics research provides an extremely effective method to access the therapeutic effects of DEX. This research will further development of new treats for status epilepticus and provide new insights into the anticonvulsive and neuroprotective effects of DEX on status epilepticus.
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Affiliation(s)
- Xingqin Tan
- Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China (mainland).,Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Zhenzhen Tu
- Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China (mainland).,Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Wei Han
- Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China (mainland)
| | - Xiaojie Song
- Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China (mainland)
| | - Li Cheng
- Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China (mainland)
| | - Hengsheng Chen
- Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China (mainland)
| | - Shengfen Tu
- Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China (mainland).,Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Pan Li
- Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China (mainland).,Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Wei Liu
- Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China (mainland).,Department of Anesthesiology, Children's Hospital of Chongqing Medical University, Chongqing, China (mainland)
| | - Li Jiang
- Pediatric Research Institute, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China (mainland).,Department of Neurology, Children's Hospital of Chongqing Medical University, Chongqing, China (mainland)
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Massey S, Banwell B. Clinical implications of status epilepticus in children. THE LANCET. CHILD & ADOLESCENT HEALTH 2018; 2:81-83. [PMID: 30169239 DOI: 10.1016/s2352-4642(17)30175-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Accepted: 12/01/2017] [Indexed: 06/08/2023]
Affiliation(s)
- Shavonne Massey
- Department of Neurology and Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Brenda Banwell
- Department of Neurology and Department of Pediatrics, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Poddar K, Sharma R, Ng YT. Intravenous Lacosamide in Pediatric Status Epilepticus: An Open-Label Efficacy and Safety Study. Pediatr Neurol 2016; 61:83-6. [PMID: 27241232 DOI: 10.1016/j.pediatrneurol.2016.03.021] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 02/25/2016] [Accepted: 03/04/2016] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Lacosamide is an antiepilepsy drug approved by the Food and Drug Administration for patients aged 17 years and older for partial-onset seizures as monotherapy or adjunctive therapy. We reviewed the use of intravenous lacosamide in children aged less than 17 years with status epilepticus. METHODS Children who received at least one dose of intravenous lacosamide for status epilepticus at our tertiary care children's hospital from December 2011 to March 2014 were studied. Status epilepticus was defined as continuous seizure activity for longer than 20 minutes or two or more recurrent seizures without regaining baseline level of awareness. Efficacy was defined as seizure freedom or more than 50% reduction of seizures within 24 hours of administering lacosamide. RESULTS Nine children with a mean age of 5.7 years (range: three months to 16 years) were included. The mean initial or loading dose was 8.7 mg/kg, with seven of nine patients receiving a dose of 10 mg/kg. The average total amount of intravenous lacosamide administered within the initial 24 hours was 13.8 mg/kg. Lacosamide was found to be efficacious in seven of nine (77.8%) patients. Four patients (44.4%) became seizure free. Two patients continued to have status epilepticus within 24 hours of lacosamide administration. Bradycardia was observed in one patient. CONCLUSION In children with status epilepticus, intravenous lacosamide was efficacious in 78% of the patients and 44% become seizure free. In addition, no significant adverse reactions were observed. An appropriate safe, effective initial, or loading dose may be 10 mg/kg.
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Affiliation(s)
- Karan Poddar
- Department of Neurology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | - Rohan Sharma
- Department of Neurology, University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
| | - Yu-Tze Ng
- Department of Pediatrics, Baylor College of Medicine, The Children's Hospital of San Antonio, San Antonio, Texas.
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Midazolam fails to prevent neurological damage in children with convulsive refractory febrile status epilepticus. Pediatr Neurol 2014; 51:78-84. [PMID: 24830769 DOI: 10.1016/j.pediatrneurol.2014.02.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2013] [Revised: 02/24/2014] [Accepted: 02/26/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND We conducted a retrospective study to compare the outcome of intravenous midazolam infusion without electroencephalography or targeted temperature management and barbiturate coma therapy with electroencephalography and targeted temperature management for treating convulsive refractory febrile status epilepticus. PATIENTS Of 49 consecutive convulsive refractory febrile status epilepticus patients admitted to the pediatric intensive care unit of our hospital, 29 were excluded because they received other treatments or because of various underlying illnesses. Thus, eight patients were treated with midazolam and 10 with barbiturate coma therapy using thiamylal. Midazolam-treated patients were intubated only when necessary, whereas barbiturate coma therapy patients were routinely intubated. Continuous electroencephalography monitoring was utilized only for the barbiturate coma group. The titration goal for anesthesia was clinical termination of status epilepticus in the midazolam group and suppression or burst-suppression patterns on electroencephalography in the barbiturate coma group. Normothermia was maintained using blankets and neuromuscular blockade in the barbiturate coma group and using antipyretics in the midazolam group. Prognoses were measured at 1 month after onset; children were classified into poor and good outcome groups. RESULTS Good outcome was achieved in all the barbiturate coma group patients and 50% of the midazolam group patients (P = 0.02, Fisher's exact test). CONCLUSIONS Although the sample size was small and our study could not determine which protocol element is essential for the neurological outcome, the findings suggest that clinical seizure control using midazolam without continuous electroencephalography monitoring or targeted temperature management is insufficient in preventing neurological damage in children with convulsive refractory febrile status epilepticus.
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Abstract
Febrile seizures are common and mostly benign. They are the most common cause of seizures in children less than five years of age. There are two categories of febrile seizures, simple and complex. Both the International League against Epilepsy and the National Institute of Health has published definitions on the classification of febrile seizures. Simple febrile seizures are mostly benign, but a prolonged (complex) febrile seizure can have long term consequences. Most children who have a febrile seizure have normal health and development after the event, but there is recent evidence that suggests a small subset of children that present with seizures and fever may have recurrent seizure or develop epilepsy. This review will give an overview of the definition of febrile seizures, epidemiology, evaluation, treatment, outcomes and recent research.
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Affiliation(s)
- DO Syndi Seinfeld
- Department of Neurology, Virginia Commonwealth University, Richmond, USA
| | - John M Pellock
- Department of Neurology, Virginia Commonwealth University, Richmond, USA
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