RESUMEN
INTRODUCTION: Studies of acute hypersensitivity reactions in pediatric populations receiving Crotalidae Polyvalent Immune Fab (CPIF) are complicated by small size, wide age ranges, and diverse definitions of such reactions. METHODS: This is a retrospective chart review of patients aged 13 years or younger treated with CPIF for Crotalid envenomation from November 2006 to 2016. The primary outcome was the presence of an acute hypersensitivity reaction to CPIF and was defined as the development of any of the following symptoms within 3 hours of initiation of CPIF infusion: urticaria, wheezing or respiratory distress, angioedema, hypotension, nausea, and/or vomiting. Demographics, CPIF dose to control and total dose, bite location, level of care, and length of stay were also recorded. RESULTS: Thirty-four patients were ultimately treated with CPIF. Ages ranged from 10 months to 13 years. Twenty-one patients (60%) were male, 24 (70.6%) were admitted to the ICU, and the median length of stay was 2 days with a range of 1-11 days. Zero patients developed an acute hypersensitivity reaction to CPIF. CONCLUSION: Acute hypersensitivity reactions to CPIF did not occur in this cohort. Such reactions are rare with the use of CPIF in pediatric patients.
Asunto(s)
Antivenenos/efectos adversos , Venenos de Crotálidos/antagonistas & inhibidores , Crotalinae , Hipersensibilidad a las Drogas/epidemiología , Fragmentos Fab de Inmunoglobulinas/efectos adversos , Mordeduras de Serpientes/tratamiento farmacológico , Adolescente , Factores de Edad , Animales , Niño , Preescolar , Venenos de Crotálidos/inmunología , Hipersensibilidad a las Drogas/diagnóstico , Hipersensibilidad a las Drogas/inmunología , Femenino , Humanos , Lactante , Masculino , Prevalencia , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Mordeduras de Serpientes/diagnóstico , Mordeduras de Serpientes/epidemiología , Mordeduras de Serpientes/inmunología , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Antihipertensivos/efectos adversos , Antimaníacos/efectos adversos , Trastorno Bipolar/tratamiento farmacológico , Síndrome de Brugada/inducido químicamente , Electrocardiografía , Frecuencia Cardíaca/efectos de los fármacos , Hipertensión/tratamiento farmacológico , Lisinopril/efectos adversos , Carbonato de Litio/efectos adversos , Trastorno Bipolar/diagnóstico , Trastorno Bipolar/psicología , Presión Sanguínea/efectos de los fármacos , Síndrome de Brugada/diagnóstico , Síndrome de Brugada/fisiopatología , Femenino , Humanos , Hipertensión/diagnóstico , Hipertensión/fisiopatología , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Medición de Riesgo , Factores de RiesgoRESUMEN
BACKGROUND: Acute cerebellar ataxia is a clinical syndrome with sudden onset of uncoordinated gait and normal mental status in young children. Although it has a benign clinical course, it often requires an exhaustive diagnostic work-up in order to rule out potentially life-threatening etiologies that present similarly. The wide differential encompasses causes from infections, brain masses, drugs, toxins, trauma, paraneoplastic syndromes, as well as hereditary or congenital disorders. CASE REPORT: We report on a 4-year-old boy with recent hand-foot-mouth disease who presented with acute cerebellar ataxia. In addition to his marked truncal ataxia and wide-based, staggering gait, he had slowness of speech, which is not commonly reported with this condition in the literature. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Emergency physicians have a unique role in being first to evaluate pediatric ataxia and can make a significant impact on identifying potentially fatal mimickers of acute cerebellar ataxia. This article will attempt to outline major diagnostic considerations in order to aid emergency physicians through their clinical approach.