Infección sistémica por citomegalovirus: influencia del tratamiento con foscarnet en los niveles plasmáticos de calcio y magnesio / Systemic cytomegalovirus infection: Changes in serum calcium and magnesium levels with foscarnet treatment

La infección por citomegalovirus es frecuente en pacientes trasplantados cardiacos. Foscarnet se utiliza, con evidencia limitada, como tratamiento de segunda línea tras el fracaso de ganciclovir en estos pacientes. Presentamos un caso de alteraciones electrolíticas por foscarnet administrado para el tratamiento de infección por citomegalovirus en un paciente pediátrico trasplantado cardiaco. La infección se resolvió tras 6 semanas de tratamiento, apareciendo niveles de calcio iónico bajos durante la infusión del fármaco e hipomagnesemia mantenida tratada con suplementos, que revirtieron al retirar el fármaco

Cytomegalovirus infection is common in cardiac transplant patients. Foscarnet is used, with limited evidence, as second-line treatment after ganciclovir failure in these patients. We describe the case of a paediatric cardiac transplant patient who developed electrolyte disturbances during foscarnet treatment for cytomegalovirus infection. The infection resolved after 6 weeks of treatment. Low ionized calcium and magnesium levels were observed during the drug infusion, which were treated with supplements. The serum levels reverted to normal after drug withdrawal

[Systemic cytomegalovirus infection: changes in serum calcium and magnesium levels with foscarnet treatment]. / Infección sistémica por citomegalovirus: influencia del tratamiento con foscarnet en los niveles plasmáticos de calcio y magnesio.

Cytomegalovirus infection is common in cardiac transplant patients. Foscarnet is used, with limited evidence, as second-line treatment after ganciclovir failure in these patients. We describe the case of a paediatric cardiac transplant patient who developed electrolyte disturbances during foscarnet treatment for cytomegalovirus infection. The infection resolved after 6 weeks of treatment. Low ionized calcium and magnesium levels were observed during the drug infusion, which were treated with supplements. The serum levels reverted to normal after drug withdrawal.

Morbimortalidad asociada al daño renal agudo en pacientes ingresados en unidades de cuidados intensivos pediátricos / Morbimortality associated to acute kidney injury in patients admitted to pediatric intensive care units

OBJETIVO: Analizar la morbimortalidad asociada a daño renal agudo (DRA) definido por los criterios RIFLE adaptados a Pediatría en los niños que ingresan en la Unidad de Cuidados Intensivos Pediátricos (UCIP). DISEÑO: Estudio retrospectivo de cohorte. Ámbito: UCIP de un hospital terciario. Pacientes o participantes: Trescientos veinte niños ingresados en la UCIP en el año 2011. Se excluyeron los neonatos y los trasplantados renales. Variables principales El DRA fue definido con los criterios RIFLE adaptados a Pediatría. Para la valoración de la morbimortalidad se utilizó la duración de las estancias en la UCIP y en el hospital, la necesidad de ventilación mecánica y la mortalidad. RESULTADOS: Se estudiaron 315 niños, con una mediana de edad de 19 meses (6-72). Presentaron DRA 128 niños (40,6%) (73 en la categoría de Risk [riesgo] y 55 en las categorías Injury [daño] y Failure [fallo]). Los niños con DRA presentaron mayor mortalidad (11,7%) que el resto de pacientes (0,5%), una estancia más prolongada en UCIP (6,0 [4,0-12,5] frente a 3,5 [2,0-7,0] días) y en el hospital (17 (10-32) frente a 10 (7-15] días) y más niños precisaron ventilación mecánica (61,7 frente a 36,9%). El desarrollo de DRA fue un factor independiente de morbilidad, asociado a una mayor estancia en UCIP y hospitalaria y a una ventilación mecánica más prolongada, incrementándose esta morbilidad de forma paralela a la gravedad del daño renal. CONCLUSIÓN: El desarrollo de DRA en niños en estado crítico se asocia a un incremento en la morbimortalidad, que es directamente proporcional a la magnitud de la gravedad del daño renal

AIM: To describe the morbimortality associated to the development of acute kidney injury (AKI) defined by the pediatric adaptation of the RIFLE criteria in a Pediatric Intensive Care Unit (PICU). DESIGN: A retrospective cohort study was carried out. SETTING: Children admitted to a PICU in a tertiary care hospital. Patients or participants A total of 320 children admitted to a tertiary care hospital PICU during the year 2011. Neonates and renal transplant patients were excluded. Primary endpoints AKI was defined and classified according to the pediatric adaptation to the RIFLE criteria. PICU and hospital stays, use of mechanical ventilation and mortality were used to evaluate morbimortality. RESULTS: A total of 315 children met the inclusion criteria, with a median age of 19 months (range 6-72). Of these patients, 128 presented AKI (73 reached the Risk category and 55 reached the Injury and Failure categories). Children with AKI presented a longer PICU stay (6.0 [4.0-12.5] vs. 3.5 [2.0-7.0] days) and hospital stay (17 [10-32] vs. 10 [7-15] days), and a greater need for mechanical ventilation (61.7 vs. 36.9%). The development of AKI was an independent factor of morbidity, associated with a longer PICU and hospital stay, and with a need for longer mechanical ventilation, with a proportional relationship between increasing morbidity and the severity of AKI. CONCLUSION: The development of AKI in critically ill children is associated with increased morbimortality, which is proportional to the severity of renal injury

Morbimortality associated to acute kidney injury in patients admitted to pediatric intensive care units.

AIM: To describe the morbimortality associated to the development of acute kidney injury (AKI) defined by the pediatric adaptation of the RIFLE criteria in a Pediatric Intensive Care Unit (PICU). DESIGN: A retrospective cohort study was carried out. SETTING: Children admitted to a PICU in a tertiary care hospital. Patients or participants A total of 320 children admitted to a tertiary care hospital PICU during the year 2011. Neonates and renal transplant patients were excluded. Primary endpoints AKI was defined and classified according to the pediatric adaptation to the RIFLE criteria. PICU and hospital stays, use of mechanical ventilation and mortality were used to evaluate morbimortality. RESULTS: A total of 315 children met the inclusion criteria, with a median age of 19 months (range 6-72). Of these patients, 128 presented AKI (73 reached the Risk category and 55 reached the Injury and Failure categories). Children with AKI presented a longer PICU stay (6.0 [4.0-12.5] vs. 3.5 [2.0-7.0] days) and hospital stay (17 [10-32] vs. 10 [7-15] days), and a greater need for mechanical ventilation (61.7 vs. 36.9%). The development of AKI was an independent factor of morbidity, associated with a longer PICU and hospital stay, and with a need for longer mechanical ventilation, with a proportional relationship between increasing morbidity and the severity of AKI. CONCLUSION: The development of AKI in critically ill children is associated with increased morbimortality, which is proportional to the severity of renal injury.