Objective: To assess the spectrum of accidental paracetamol-induced liver disease (PILD) in children and to study the pediatrician's perspective on the possible reasons and remedial measures.
Materials and Methods: A questionnaire-based online survey among pediatricians all over India was sent to members of the Indian Academy of Pediatrics (IAP), the Indian Society of Pediatric Gastroenterology, Hepatology and Nutrition (ISPGHAN), and institutions.
Results: 86% considered PILD in their diagnosis and 42% had encountered one or more cases in the previous 6 months. 54% reported acute hepatitis as the most common presentation. Half the respondents attributed it to an error by the mother while 30% held the pharmacists responsible. As remedial measures, a majority suggested color coding of different strengths and mentioning the dose in bold letters on preparations containing drops.
Conclusion: Accidental PILD among children is not uncommon but is preventable and treatable. It should be considered in the differential diagnosis of acute hepatitis. Steps to prevent errors by the mother and pharmacist are easy to enforce.
Andrew James Simon,
Arul Premanand Lionel
Galactosemia is an autosomal recessive disorder of galactose metabolism. Classical galactosemia presents in infancy with jaundice, coagulopathy, ascites, failure to thrive, sepsis, cataract, etc. In spite of hypoglycemia being a known complication in sick galactosemic infants, blood glucose estimation at times provides false high glucose values in point - of - care (POC) devices suggestive of hyperglycemia. Though these false values are due to its fallacies in technical aspects of glucose estimation, as it wrongly identifies the elevated galactose levels as glucose levels, the discrepancy between POC and laboratory values of blood glucose in sick neonatal cholestasis helps in arriving at the diagnosis in a resource-limited setting. Here, we describe a galactosemic infant presented with jaundice, ascites, and bilateral cataract. The high blood glucose levels (200–300 mg/dL) in POC devices were documented at the time of admission. However, the corresponding laboratory venous blood glucose levels were low (50–70 mg/dL). These high blood glucose values in POC devices gradually lowered after a lactose-free diet was introduced.
Foreign body (FB) ingestions are one of the most common pediatric gastroenterology emergencies. Among them, management of multiple magnets can be challenging due to various factors influencing clinical decision-making. These include presence of symptoms, their relation to one another, location/removability through endoscopy, and their position in serial X-rays. Here we report outcomes in three children where one child had three magnets in post-pyloric location, but appeared to be within the reach and was asymptomatic after a brief symptomatic phase. On successive X-rays, FB was in the same location and therefore required surgical removal due to development of fistula. The second child with magnets in post-pyloric was managed conservatively as the child was asymptomatic and they were moving in sequential X-rays. The third child required endoscopic removal due to the presence of symptoms, with all magnets lying together in pre-pyloric location. These cases feature the management of multiple magnets ingestion in varied clinical scenarios.