ABSTRACT
PURPOSE: Hyperosmolar therapy is a mainstay in the acute medical management of traumatic brain injury (TBI). Emerging literature suggests that a hyperosmolar state may lead to thrombotic complications. The primary objective of this study was to investigate associations between hypertonic saline (HTS) and the outcome of deep venous thrombosis (DVT) in pediatric patients with severe TBI. MATERIALS AND METHODS: This is a single-center retrospective cohort study of 58 patients admitted to the intensive care unit at a Level 1 pediatric trauma center between January 2010 and June 2013. Main measurements included volume of HTS administration, serum sodium levels, DVT confirmed with ultrasonography, survival at 30 days postinjury, and Glasgow Outcome Scale. RESULTS: The cumulative total bolus volume of HTS (mL/kg) given to each subject was associated with DVT (P=.01). Peak sodium level and 72-hour sustained sodium levels were associated with DVT (P=.05). A sustained sodium level of at least 160 mmol/L was associated with DVT (P=.02). CONCLUSION: In children with severe TBI, the total bolus volume of 3% HTS and sustained sodium levels greater than 160 mmol/L are independently associated with DVT.
Subject(s)
Brain Injuries/therapy , Saline Solution, Hypertonic/adverse effects , Venous Thrombosis/etiology , Adolescent , Brain Injuries/blood , Brain Injuries/complications , Child , Child, Preschool , Cohort Studies , Female , Glasgow Outcome Scale , Humans , Infant , Intensive Care Units, Pediatric/statistics & numerical data , Logistic Models , Male , Retrospective Studies , Saline Solution, Hypertonic/therapeutic use , Sodium/blood , Survival Analysis , Ultrasonography , Venous Thrombosis/diagnostic imagingABSTRACT
Human metapneumovirus (hMPV) is a relatively recent addition to the multiplicity of viruses causing respiratory illness in infants and children. Although well described in its ability to cause respiratory illness, there is limited data detailing the association of hMPV with neurologic complications. In this report, we describe 2 toddlers with hMPV infection who presented in status epilepticus and went on to develop respiratory failure. Both patients fully recovered over 2 weeks and were discharged from the hospital with no sequelae. The association between hMPV infection and neurologic complications is increasingly being reported in the literature. Clinicians should be aware of these uncommon manifestations of a common respiratory pathogen and consider testing for hMPV when managing pediatric patients who present with unexplained status epilepticus or encephalitis.