Citrullinemia, a rare cause of recurring encephalopathy.

An infant presented with recurrent episodes of encephalopathy, responding to nonspecific management of sepsis. High index of suspicion helped uncover underlying error of metabolism.

Gastropleural Fistula in a Child with Acute Lymphoblastic Leukemia Due to Perforated Gastric Ulcer.

Gastropleural fistula (GPF) is a pathological communication between stomach and pleural cavity. GPF is described rarely in adults following bariatric surgery, iatrogenic perforations, complicated empyema thoracis, penetrating chest trauma, perforated malignant gastric ulcers, and invasive tumors. GPF in children is extremely rare. The authors describe a female child with leukemia, who presented with left-sided pneumonia and chylothorax. After a delay of around 3 wk she was diagnosed with GPF, which was due to a perforated gastric ulcer induced by high-dose steroids which she was receiving as chemotherapy. She was managed with repair of GPF and had a favorable outcome.

Comparison of Antipyretic Efficacy of Intravenous (IV) Acetaminophen versus Oral (PO) Acetaminophen in the Management of Fever in Children.

OBJECTIVE: To assess the dynamics of the onset of antipyretic efficacy of intravenous (IV) acetaminophen vs. oral (PO) acetaminophen in the management of fever in children. METHODS: This observational single-dose study was conducted at Department of Pedriatrics, Army Hospital (Research and Referral), a multispecialty tertiary care center in New Delhi in fever patients to assess the antipyretic efficacy of IV acetaminophen 15 mg/kg/dose vs. PO acetaminophen 15 mg/kg/dose over 6 h. Subjects were randomly assigned to receive either IV acetaminophen (n = 200) or PO acetaminophen (n = 200). RESULTS: Demographics and baseline characteristics were similar between the two groups and were normally distributed. Allergic reaction was found in 7 (3.5%) patients in IV acetaminophen group and was absent in PO acetaminophen group. Onset of constipation and dry mouth was found in 8 patients (4%) in IV acetaminophen group and was absent in PO acetaminophen group. Additional dose was required in 6 patients (3%) in intravenous acetaminophen group and 10 patients (5%) in oral acetaminophen group respectively. Statistically significant differences in the rate of fall in temperature through 180 min were observed in favor of the IV acetaminophen group when compared to those receiving PO acetaminophen. CONCLUSIONS: A single dose of intravenous acetaminophen is safe and effective in reducing fever where patients are unable to tolerate oral administration or when rapid reduction of temperature is desirable.