Although the administration of crystalloid fluids is one of the most frequently used treatment procedures, we often forget that the administration of fluids should be governed by the same rules that apply to the administration of any medicinal product. Fluid administration has its indications and contraindications, the exact dose should be defined and both therapeutic effects and goals, as well as possible adverse effects accompanying fluid administration, should be monitored. Each time a crystalloid fluid is administered, we must think about its composition in the context of the patient's clinical condition, and from this point of view, we should individualize the treatment. The aim of this article is to describe the physiology and pathophysiology of fluids, to clarify the historical context of the development of the composition of crystalloid fluids used in clinical practice, and to provide an up-to-date view of the therapeutic parenteral administration of crystalloid fluids in children from infancy to 18 years of age. The information in the article does not relate to the neonatal age and does not address the enteral form of rehydration.
- MeSH
- dehydratace terapie MeSH
- dítě MeSH
- krystaloidní roztoky MeSH
- lidé MeSH
- rehydratační roztoky MeSH
- renin-angiotensin systém MeSH
- tekutinová terapie * metody MeSH
- vasopresiny MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- Publikační typ
- přehledy MeSH
OBJECTIVES: Stroke volume (SV) and cardiac output monitoring is a cornerstone of hemodynamic assessment. Noninvasive technologies are increasingly used in children. This study compared SV measurements obtained by transcutaneous Doppler ultrasound techniques (ultrasonic cardiac output monitor [USCOM]), transthoracic echocardiography jugular (TTE-J), and parasternal (TTE-P) views performed by pediatric intensivists (OP-As) with limited training in cardiac sonography (20 previous examinations) and pediatric cardiologists (OP-Bs) with limited training in USCOM (30 previous examinations) in spontaneously ventilating children. METHODS: A single-center study was conducted in 37 children. Each operator obtained 3 sets of USCOM SV measurements within a period of 3 to 5 minutes, followed with TTE measurements from both apical and jugular views. The investigators were blinded to each other's results to prevent visual and auditory bias. RESULTS: Both USCOM and TTE methods were applicable in 89% of patients. The intraobserver variability of USCOM, TTE-J, and TTE-P were less than 10% in both investigators. The SV measurements by OP-As using USCOM, TTE-J, and TTE-P were 46.15 (25.48) mL, 39.45 (20.65) mL, and 33.42 (16.69) mL, respectively. The SV measurements by OP-Bs using USCOM, TTE-J, and TTE-P were 43.99 (25.24) mL, 38.91 (19.98) mL, and 37.58 (19.81) mL, respectively.The percentage error in SV with USCOM relative to TTE-J was 36% in OP-As and 37% in OP-Bs. The percentage error in SV with TTE-P was 33% relative to TTE-J in OP-As and 21% in OP-Bs. CONCLUSIONS: Our findings show that the methods are not interchangeable because SV values by USCOM are higher in comparison with the SV values obtained by TTE. Both methods have low level of intraobserver variability. The SV measurements obtained by TTE-P were significantly lower compared with the TTE-J for the operator with limited training in echocardiography. The TTE-P requires longer practice compared with the TTE-J; therefore, we recommend to prefer TTE-J to TTE-P for inexperienced operators.
Syndrom přerušené stopky hypofýzy (PSIS, pituitary stalk interruption syndrome) je jednou z příčin vrozeného hypopituitarismu. Vzniká na genetickém podkladě v důsledku poruchy morfogeneze hypofýzy. Typickým nálezem na magnetické rezonanci mozku (MR) je hypoplazie nebo aplazie adenohypofýzy, ektopicky uložená neurohypofýza a chybění nebo ztenčení stopky hypofýzy. Vzácnou příčinou získaného hypopituitarismu může být v dětském věku autoimunitní hypofyzitida. Prezentujeme případ 11leté dívky, u které byl při záchytu iniciální fáze diabetes mellitus 1. typu (DM) současně zjištěn kombinovaný pituitární deficit růstového hormonu, centrální hypotyreóza a centrální hypokortikalismus. K diagnóze hypopituitarismu vedla růstová porucha s progresivní růstovou retardací přítomnou od 7 let věku dítěte. V diferenciální diagnóze bylo primárně pomýšleno na autoimunitní hypofyzitidu, nález na MR mozku však svědčil pro PSIS. Deficit kortisolu a růstového hormonu ovlivnil manifestaci DM a iniciální potřebu inzulinu před zahájením substituční hormonální terapie hydrocortisonem a růstovým hormonem.
Pituitary stalk interruption syndrome (PSIS) is one of the causes of congenital hypopituitarism. It is based on a genetically-linked disorder of pituitary morphogenesis. Typical findings on magnetic resonance imaging (MRI) of the brain are hypoplasia or aplasia of anterior pituitary lobe, ectopic posterior pituitary lobe, and absent or thin pituitary stalk. A rare cause of acquired hypopituitarism in children may be autoimmune hypophysitis.We present a case of an 11-year-old girl with simultaneously diagnosed combined pituitary growth hormone deficiency, central hypothyroidism, central hypocorticalism and the initial phase of diabetes mellitus type 1 (DM). The diagnosis of hypopituitarism was based on a growth disorder with progressive growth retardation from the age of 7 years. In the differential diagnosis, autoimmune hypophysitis was primarily considered, but the brain MRI finding suggested PSIS. The deficiency of cortisol and growth hormone affected the manifestation of DM and the initial need for insulin before initiating hydrocortisone and growth hormone replacement therapy.
- Klíčová slova
- syndrom přerušené stopky hypofýzy, autoimunitní hypofysitida,
- MeSH
- diabetes mellitus 1. typu diagnóza terapie MeSH
- dítě MeSH
- hypopituitarismus diagnóza MeSH
- lidé MeSH
- poruchy růstu * diagnóza etiologie terapie MeSH
- výsledek terapie MeSH
- Check Tag
- dítě MeSH
- lidé MeSH
- ženské pohlaví MeSH
- Publikační typ
- kazuistiky MeSH
Práce popisuje kazuistiku vzácné kombinace dvou výše zmíněných genetických syndromů s familiárním výskytem (obr. 4) diagnostikovaných již prenatálně u novorozence s komplikovanou perinatální anamnézou. Ve vlastní kazuistice a přiložené fotodokumentaci je zdůrazněna přítomnost typických klinických příznaků pro jednotlivá onemocnění.
The paper describes a case study of a rare combination of the two above-mentioned genetic syndromes with familial incidence (Fig. 4) diagnosed prenatally in a newborn with a complicated perinatal history. The actual case report and the attached photographic documentation emphasize the presence of typical clinical symptoms for individual diseases.
