Management of hypothermic submersion associated cardiac arrest in a 5-year-old child: A case report.

We report a case of severe accidental hypothermia (core body temperature of 26.8 °C) in a five-year-old boy due to submersion in freezing lake water. The child was brought to the hospital intubated, in cardiac arrest rhythm of pulseless electrical activity and with dilated and nonreactive pupils. We continued with cardiopulmonary resuscitation and administrated adrenaline in boluses (10 µg/kg) and infusion (0.2 µg/kg/min). Spontaneous circulation returned after 50 minutes. Rewarming was performed with minimally invasive techniques. Post resuscitation he was admitted to the intensive care unit, where he required venovenous extracorporeal membrane oxygenation due to respiratory failure. He was discharged from the hospital neurologically intact and without organ damage on day 17 post arrest.

Intrathecal immunoglobulin synthesis: The potential value of an adjunct test.

BACKGROUND: Detection of cerebrospinal fluid (CSF) specific oligoclonal bands (OCB) supports the diagnosis of multiple sclerosis (MS), but the method is technically demanding and gives only qualitative information. Kappa free light chains (KFLC) quantification could represent a convenient alternative. We evaluated the diagnostic accuracy of OCB and KFLC in our cohort to further estimate the gain in diagnostic performance when combining both of them. METHODS: KFLC were measured in paired serum and CSF samples of 80 patients with MS and 50 patients with non-inflammatory neurological disorders. OCB were detected using an in-house alkaline phosphatase assay. Likelihood ratio (LR) was used to explore the benefit of the combined KFLC and OCB test. RESULTS: Sensitivity of KFLC index (≥5.3) and intrathecal KFLC fraction (≥10%) was 96% and 95% respectively, compared to 91% sensitivity of OCB assay. Specificity was 96% for intrathecal KFLC synthesis and 98% for OCB. Probability of MS in the absence of OCB was further reduced with concurrently normal KFLC index. CONCLUSIONS: Normal KFLC parameters allow confident exclusion of intrathecal inflammation, but probability of MS is greater with positive OCB. Use of KFLC as an adjunct test might be beneficial in specialized MS centers with larger pretest probability.