Indian Journal of Trauma and Emergency Pediatrics

Edward Anthony Jenner (17 May 1749 – 26 January 1823) was an English scientist who studied his natural surroundings in Berkeley, Gloucestershire. Jenner is widely credited as the pioneer of smallpox vaccine, and is sometimes referred to as the ‘Father of Immunisation’. Jenner’s works ‘have saved more lives than the work of any other man’.
 

Acute liver failure is a complex multi system disorder that results from an acute severe insult to the liver in a previously well child. It has an unpredictable course and high mortality in children. Encephalopathy and uncorrectable coagulopathy are essential pre requisites in diagnosis. Metabolic diseases are the commonest cause in infants. Viral hepatitis predominates in older children. A large percentage of children have no identifiable cause.  Management of a child with ALF includes basic intensive care to ensure regulation of fluid status, glucose and electrolyte homeostasis and specific measures to reduce serum ammonia concentration, as well as the prevention and prompt treatment of complications. Important complications that require urgent recognition and management include coagulopathy, cerebral edema, sepsis and renal dysfunction. Cerebral edema is the most important reason for death in acute liver failure. Increasing jaundice, uncorrected prothrombin time and rapidly falling ALT values in a clinically deteriorating patient indicates poor prognosis. Management is aimed at life support and prevention of complications, while facilitating regeneration of the liver. Liver transplantation is the only definitive treatment that improves outcome.

Key words: encephalopathy, coagulopathy, cerebral edema, liver transplantation.

Septic shock is one of the common pediatric emergencies often encountered. Despite the advances in the preventive and therapeutic medicines, septic shock continues to be a major life threatening problem. This review article tries to highlight some of the management issues for the septic shock in children.

Key words: Sepsis, septic shock, diagnostic criteria, management

Acute renal failure is an important cause of morbidity and mortality in children. Since it has been variously defined in the past, leading to wide variations in the reported incidence and mortality of the condition, the Acute Kidney Injury Network (AKIN), an expert body comprising of nephrologists and intensivists worldwide, has replaced the term ‘acute renal failure’ by ‘acute kidney injury (AKI)’ and adopted a uniform definition and classification for the new terminology. The new AKIN classification is useful since early detection of AKI helps in commencement of several preventive and therapeutic strategies including avoidance of potentially nephrotoxic drugs, judicious usage of radio-contrast imaging studies, appropriate fluid management, correction of acid-base and electrolyte disturbances, and optimization of blood pressure control. It also allows rational comparison of studies that assess preventive and therapeutic AKI strategies, helps in generalization of data generated from single center studies, and allows patient stratification based on AKI severity. AKI has a wide differential diagnosis. History can help classify the pathophysiology of AKI as prerenal, intrinsic renal or postrenal failure, and may suggest a specific etiology.  While sepsis, glomerulonephritis, hemolytic uremic syndrome, acute tubular necrosis and obstructive nephropathy predominate in developing countries, these have been replaced by hemato-oncologic complications and pulmonary failure as causes of AKI in the western world. This review summarizes the epidemiology, etiopathogenesis, evaluation and management of children with AKI. Current concepts regarding pharmacological interventions for early management of AKI and the long term outcome of pediatric AKI are also discussed.

Key words: Acute kidney injury; RIFLE classification; Renal replacement therapy

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