Hipocalcemia sintomática secundaria a raquitismo carencial. Presentación de dos casos clínicos / Symptomatic hypocalcaemia due to nutritional rickets. A presentation of two cases

Introducción: El raquitismo nutricional es una enfermedad considerada infrecuente en los países desarrollados, y el aumento en su incidencia se relaciona con el incremento de la inmigración en nuestro medio. Debido al incremento de esta patología en España, debemos aumentar nuestra sospecha diagnóstica y ser capaces de detectarla aún cuando se presente con síntomas poco usuales. Objetivo: Se presentan 2 casos clínicos de lactantes que debutaron con hipocalcemia sintomática y que fueron diagnosticados de raquitismo carencial. Caso 1. Lactante de 6 meses que presenta episodios de convulsiones tónicas e irritabilidad, sin otros hallazgos en la exploración física, constatándose una hipocalcemia secundaria a un raquitismo carencial. Caso 2. Lactante de 7 meses que realiza episodios de hipertonía generalizada, estridor inspiratorio e irritabilidad, con el resto de la exploración física normal, en el que también se constata hipocalcemia secundaria a raquitismo. Discusión: El concepto antiguo de que el raquitismo es una entidad rara en nuestro medio nos lleva muchas veces a descartar esta patología, retrasando el diagnóstico y el tratamiento. Debemos revisar nuestros conceptos y ser capaces de detectar síntomas frecuentes y también los poco usuales del raquitismo nutricional (AU)

Introduction: The nutritional rickets is considered an uncommon disease in developed countries, but the increase in its incidence appears to be related to the increase in the number of immigrants in these countries. Thus in Spain, we must increase our diagnostic suspicion of this disease and be able to detect it, even when it appears with unusual symptoms. We describe two clinical cases of breast-fed babies who presented with symptomatic hypocalcaemia and were diagnosed with rickets. Case 1. A six month-old breast-fed baby who had episodes of tonic seizures and irritability, with no other findings in the physical examination, and diagnosed with secondary hypocalcaemia due to nutritional rickets. Case 2. A seven month-old breast-fed baby who had generalised hypertonia, stridor and irritability, with a normal physical examination, and also diagnosed with hypocalcaemia secondary to rickets. Discussion: The old concept that rickets is a rare condition in our country means that we often tend to rule out this pathology, thus delaying the diagnosis and the treatment. We must review our concepts in order to be able to detect the common and also the unusual symptoms of nutritional rickets (AU)

[Symptomatic hypocalcaemia due to nutritional rickets. A presentation of two cases]. / Hipocalcemia sintomática secundaria a raquitismo carencial. Presentación de dos casos clínicos.

INTRODUCTION: The nutritional rickets is considered an uncommon disease in developed countries, but the increase in its incidence appears to be related to the increase in the number of immigrants in these countries. Thus in Spain, we must increase our diagnostic suspicion of this disease and be able to detect it, even when it appears with unusual symptoms. We describe two clinical cases of breast-fed babies who presented with symptomatic hypocalcaemia and were diagnosed with rickets. Case 1. A six month-old breast-fed baby who had episodes of tonic seizures and irritability, with no other findings in the physical examination, and diagnosed with secondary hypocalcaemia due to nutritional rickets. Case 2. A seven month-old breast-fed baby who had generalised hypertonia, stridor and irritability, with a normal physical examination, and also diagnosed with hypocalcaemia secondary to rickets. DISCUSSION: The old concept that rickets is a rare condition in our country means that we often tend to rule out this pathology, thus delaying the diagnosis and the treatment. We must review our concepts in order to be able to detect the common and also the unusual symptoms of nutritional rickets.

[Usefulness of acid-base and electrolyte balance in acute gastroenteritis]. / Utilidad del equilibrio ácido-base y del ionograma en el tratamiento de la gastroenteritis aguda.

INTRODUCTION: Blood analysis blood is frequently requested for evaluating patients with acute gastroenteritis who come to our emergency department, but there are few studies that determine its real usefulness in the management of these patients. OBJECTIVES: a) To determine the reasons why paediatricians request laboratory tests in patients with acute gastroenteritis; b) to establish the type and frequency of laboratory abnormalities found in these patients; c) to evaluate the ability of paediatricians to predict laboratory abnormalities in children with acute gastroenteritis from the history and physical examination; d) to assess the frequency with which these laboratory findings change the initial management of the patient, and e) to determine whether there is an association between clinical and analytical results, and length of hospital stay. PATIENTS AND METHODS: Over a period of 4 months, children between 3 months and 18 years with symptomatic acute gastroenteritis seen in the emergency department and had laboratory tests requested by the paediatrician were included. RESULTS: Of the 4,172 children seen with acute gastroenteritis, 163 patients who had laboratory tests done were included in the study. The most common reason for requests was clinical suspicion of dehydration in 67.5 %. Abnormal results were seen in 77.9 % of cases, mainly metabolic acidosis (72.4 %). The sensitivity analysis to predict an analytical abnormality was 64.6 % with a specificity of 61.1 %. Electrolyte disorders caused a change in the initial management in 12.3 % of patients, with 85.3 % of patients requiring hospital admission; bicarbonate, sodium, creatinine and urea values correlated with a hospital stay of more or less 24 hours. CONCLUSIONS: History and physical examination have limitations in predicting the presence of clinically significant electrolyte abnormalities in patients without clinical signs of dehydration or mild dehydration. Some laboratory tests correlate well with the length of patient stay in hospital.

Utilidad del equilibrio ácido-base y del ionograma en el tratamiento de la gastroenteritis aguda / Usefulness of acid-base and electrolyte balance in acute gastroenteritis

Introducción: La analítica sanguínea es solicitada frecuentemente para valorar a los pacientes con gastroenteritis aguda atendidos en urgencias, pero existen escasos estudios que determinen su utilidad real en el tratamiento de dichos pacientes. Objetivos: Nuestro estudio tiene los siguientes objetivos: a) determinar los motivos para que los pediatras soliciten una analítica en pacientes con gastroenteritis aguda; b) establecer el tipo y la frecuencia de las alteraciones analíticas encontradas en estos pacientes; c) valorar la capacidad de los pediatras para predecir alteraciones analíticas en niños con gastroenteritis aguda a partir de la anamnesis y la exploración física; d) evaluar la frecuencia con la que estas alteraciones analíticas producen cambios en el tratamiento inicial del paciente, y e) determinar si existe una asociación entre las variables clínicas y los resultados analíticos, y la duración de la estancia hospitalaria. Pacientes y métodos: Se incluyen en el estudio niños de edades comprendidas entre 3 meses y 18 años con síntomas de gastroenteritis aguda atendidos en el servicio de urgencias durante un período de 4 meses y para quienes se solicita analítica de sangre a criterio del pediatra. Resultados: De 4.172 niños atendidos por gastroenteritis aguda, se incluyeron en el estudio 163 pacientes a quienes se les practicó un estudio analítico. El motivo más frecuente para solicitar una analítica fue, en un 67,5 %, la sospecha clínica de deshidratación. Se objetivó una analítica alterada en el 77,9 % de los casos, destacando la acidosis metabólica (72,4 %). La sensibilidad para predecir una alteración analítica fue del 64,6 %, con una especificidad del 61,1 %. Los trastornos iónicos condicionaron un cambio en el tratamiento inicial del paciente en un 12,3 % de los casos. El 85,3 % de los pacientes requirió ingreso hospitalario; los valores de bicarbonato, sodio, urea y creatinina se correlacionaron con una estancia hospitalaria mayor o menor de 24 h. Conclusiones: La anamnesis y la exploración física presentan limitaciones para predecir la existencia de alteraciones hidroelectrolíticas clínicamente relevantes en pacientes sin signos clínicos de deshidratación o con deshidratación leve. Algunos parámetros analíticos presentan una buena correlación con el tiempo de permanencia hospitalaria del paciente (AU)

Introduction: Blood analysis blood is frequently requested for evaluating patients with acute gastroenteritis who come to our emergency department, but there are few studies that determine its real usefulness in the management of these patients. Objectives: a) To determine the reasons why paediatricians request laboratory tests in patients with acute gastroenteritis; b) to establish the type and frequency of laboratory abnormalities found in these patients; c) to evaluate the ability of paediatricians to predict laboratory abnormalities in children with acute gastroenteritis from the history and physical examination; d) to assess the frequency with which these laboratory findings change the initial management of the patient, and e) to determine whether there is an association between clinical and analytical results, and length of hospital stay. Patients and methods: Over a period of 4 months, children between 3 months and 18 years with symptomatic acute gastroenteritis seen in the emergency department and had laboratory tests requested by the paediatrician were included. Results: Of the 4,172 children seen with acute gastroenteritis, 163 patients who had laboratory tests done were included in the study. The most common reason for requests was clinical suspicion of dehydration in 67.5 %. Abnormal results were seen in 77.9 % of cases, mainly metabolic acidosis (72.4 %). The sensitivity analysis to predict an analytical abnormality was 64.6 % with a specificity of 61.1 %. Electrolyte disorders caused a change in the initial management in 12.3 % of patients, with 85.3 % of patients requiring hospital admission; bicarbonate, sodium, creatinine and urea values correlated with a hospital stay of more or less 24 hours. Conclusions: History and physical examination have limitations in predicting the presence of clinically significant electrolyte abnormalities in patients without clinical signs of dehydration or mild dehydration. Some laboratory tests correlate well with the length of patient stay in hospital (AU)