Dilated Cardiomyopathy Due to Alimentary Iron Deficiency.

Dilated cardiomyopathy (DCM) is a severe condition, characterised by left ventricular dilation and systolic dysfunction, necessitating heart transplantation when all other treatment options fail. This case report describes a 2-year-old girl initially presenting with oedema, listlessness, and severe iron deficiency anaemia. She was diagnosed with DCM. Extensive diagnostic workup ruled out other causes, leading to the suspicion of DCM due to alimentary iron deficiency. This was confirmed by the parents' report that the girl was fed almost exclusively with low-fat cow's milk. Prompt treatment, including packed red cell transfusion, iron supplementation, and heart failure medications (diuretics, ACE inhibitors, beta blockers, and aldosterone antagonists), resulted in significant improvement in cardiac function within days. This report demonstrates the potential risks of alimentary iron deficiency, the most common cause of microcytic hypochromic anaemia in young children, which might even result in the development of life-threatening cardiac dysfunction in extreme cases.

Carbon dioxide versus room air for colonoscopy in deeply sedated pediatric patients: a randomized controlled trial.

Background and study aims Use of carbon dioxide (CO 2 ) instead of room air (RA) during colonoscopy in adults revealed significantly less flatulence and abdominal pain in several studies. The objectives of this study were to investigate the effects of CO 2 usage on post-interventional pain, abdominal discomfort, abdominal girth, pCO 2 levels, and narcotic requirement in deeply sedated pediatric patients. Patients and methods A total of 97 children and adolescents aged 4 years to 17 years undergoing colonoscopy were randomized to RA or CO 2 in a prospective, randomized, controlled trial. Age-appropriate pain scales assessed abdominal pain as primary outcome. In addition, abdominal girth, abdominal bloating, transcutaneous pCO 2 , narcotic requirement to achieve deeply sedation, and post-procedural analgesic demand was analyzed in 73 patients. Results Overall, significantly fewer patients reported bloating in the CO 2 group ( P  = 0.0012). However, we observed only a trend to lower post-interventional pain ( P  = 0.15) and a lower pain score. There was no significant difference in transcutaneous pCO 2 level and no adverse events occurred. Although there was no difference in the dosage of propofol and midazolam, we observed a significant increased necessity for use of synthetic opioids in the RA group to achieve optimal examination conditions ( P  = 0.023). Conclusions The benefits using CO 2 in colonoscopy of deeply sedated children predominate. In particular, CO 2 insufflation may allow a less painful post-interventional time and it significantly reduces abdominal bloating. Moreover, with CO 2 , significantly less additional opioids were used. Thus, CO 2 insufflation can be considered as safe in deeply sedated patients as there was no relevant pulmonary CO 2 retention observed. (DRKS00013914).