Indian Journal of Trauma and Emergency Pediatrics

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A 3 month old male infant presented with intractable seizures following administration of neem oil. Seizures were refractory in nature with features of raised intracranial tension and was managed with thiopentone, mechanical ventilation, midazolam infusion and mannitol. Investigations revealed REYE’s syndrome like picture and diffuse cerebral oedema with frontal cortical atrophy in CT brain. Subsequently the child had presented with loss of gained milestone( social smile) and nonattainment of further developmental milestones, persistent hypotonia and myoclonic seizures on follow up at 5th month of life. Inview of myoclonic seizures, hypotonia and developmental regression with parental consanguinity, inborn error of metabolism was suspected. On evaluation, child was found to have significantly elevated levels of 2-hydroxyglutarate, succinate & adipate on Gas chromatography mass spectrometry (GCMS) which was suggestive of gutaric aciduria type II.

Key words: neem oil poisoning, glutaric aciduria. 

 Shock or circulatory collapse is one of the most common emergencies confronted in the Neonatal ICU. Decreased tissue oxygen delivery is the underlying pathology which may result from decreased preload, cardiac contractility/output or imbalance in afterload. Prompt recognition is based on clinical findings suggestive of decreased peripheral or specific organ perfusion. Confirmation by newer methods like Superior vena cava blood flow by Doppler and use of therapeutic targets like Mixed venous oxygen saturation have favourably changed the outcome of management of shock. This review is aimed at highlighting certain facts and clarifying a few controversies confronted during treatment.

Key words: Shock, Sepsis, Newborn, Management

Solvent sniffing has become of increasing concern in the last few decades with the widespread availability of solvent-based chemical products. The people using it can present to emergency department with sudden sniffing death and some times with multi organ dysfunction. So one has to keep in mind the possibility of solvent sniffing also in children presenting with such life threatening features.

Key Words: Siddem sniffing death, grandiosity, Immense strength, slurred speech 

Idiopathic Ketotic Hypoglycemia is the most common non-iatrogenic cause of hypoglycemia in children beyond infancy. It improves with age and is rare after puberty. Early morning hypoglycemia, responding promptly to glucose, is a typical presentation. Etiology of hypoglycemia is unclear; deficiency of gluconeogenic substrate (hypoalaninemia) has been widely proposed. Idiopathic Ketotic Hypoglycemia is a diagnosis of exclusion. Rule out specific etiologies first. Ketonuria precedes hypoglycemia by several hours, testing for ketonuria helps in early detection. For prevention, avoiding fasting states and bedtime snacks are helpful.

Keywords: Ketotic hypoglycemia, children, hypoalaninemia 

Children and adolescents presenting to emergency department for mental health problems constitute a small percentage. ‘Emergency’ in this group is different from the conventional medical emergency seen in seriously ill children presenting to emergency department. Parents bring their children as last resort to emergency department for acute behavioral problems. There is need to identify common psychiatric emergencies in these group and institute appropriate interventions before making referral plan. In future, there is likely to be an increase in the burden of morbidity due to neuropsychiatric conditions in children and adolescents as per WHO predictions. Though most common reason for emergency visits is for suicide attempt or violence, there is need to understand the underlying psychiatric disorders. As there are almost no community services for children and adolescents with mental health or substance use problems, and not adequate specialists to deal with these problems, makes them present to the emergency more frequently. Here lies the preparedness of pediatric residents to acquire competency to deal with such emergencies and to develop appropriate consultation-liaison services for children and adolescents with these special needs.

Keywords: adolescents, children, emergency psychiatry

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