RESUMEN
BACKGROUND: The use of complementary and alternative medicine (CAM) is widespread in children with cancer and is poorly regulated. PATIENTS AND METHODS: Case report. RESULTS: We describe a case of severe cyanide poisoning arising from CAM use. A severely agitated, encephalopathic, unresponsive 4-year-old boy (initial Glasgow Coma Scale of 3) with a history of metastatic ependymoma was brought to our emergency department by ambulance services. Initial blood gas analysis demonstrated severe metabolic/lactic acidosis. On detailed questioning of the parents, the use of CAM including intravenous and oral "vitamin B 17" (amygdalin) and oral apricot kernel was reported. After administering sodium thiosulfate, rapid improvement in his medical condition with complete recovery without need for further intensive care treatment was seen. Serum cyanide level was markedly elevated. CONCLUSIONS: Cyanide poisoning can be the cause of severe encephalopathy in children receiving CAM treatment with substances containing cyanogenic glycosides.
Asunto(s)
Amigdalina/envenenamiento , Neoplasias Encefálicas/tratamiento farmacológico , Terapias Complementarias/efectos adversos , Cianuros/envenenamiento , Ependimoma/tratamiento farmacológico , Nitrilos/envenenamiento , Fitoterapia/efectos adversos , Prunus armeniaca/envenenamiento , Semillas/envenenamiento , Administración Intravenosa , Administración Oral , Encefalopatías/inducido químicamente , Encefalopatías/tratamiento farmacológico , Preescolar , Humanos , Enfermedad Iatrogénica , Masculino , Tiosulfatos/uso terapéuticoRESUMEN
AIM: We investigated the associations between staff work characteristics, parents' experiences and a number of medical outcome measures. METHODS: This explorative multicentre study took place in the neonatal intensive care units (NICUs) of five German university hospitals between 2009 and 2011. We assessed staff work characteristics by surveying 126 NICU nurses and 57 physicians and asked 214 parents about their relationships with staff. The outcome variables of 230 premature infants with birth weights of less than 1500 g were collected over a period of 18 months. We used analysis of variance (ANOVA) and regression analyses for statistical purposes. RESULTS: We found differences in outcome measures between the NICUs, particularly parameters of respiratory support, weight gain and length of stay. When we controlled for the NICUs' baseline factors, perceptions of the relationship between staff and parents (empathy, p < 0.001; conversation duration and frequency, p < 0.05; familiarity, p < 0.05) and staff work characteristics (workload, p < 0.05) were associated with at least one of these outcome measures. CONCLUSION: Staff and parents were discriminators for neonatal outcomes through perceptions of work characteristics and the relationship between staff and parents, respectively. Respiratory support and nutrition measures were particularly sensitive. This research has prompted a nationwide, multicentre study of 66 NICUs.