Ingestion — Associated adverse events necessitating pediatric ICU admissions

Objective  To review the pattern of food-associated pediatric intensive care unit (PICU) admissions. Methods  A retrospective chart review was conducted to analyse the pattern of food-associated PICU admissions at a teaching hospital between January 2004 and May 2007. Results  Ten cases (7 boys and 3 girls, aged 9 month to 11.7 year) were identified. One girl developed progressive generalized urticarial rash and anaphylactic shock following consumption of bird nest drink. A boy presented with the classic triads of acute onset altered mental state, respiratory depression and small pupils following consumption of a bottle of presumed “green tea”, which was subsequently found to contain methadone. In the remaining 8 cases, dried mango, peanut, peanut-shell, fishmeat ball, pork chop, bread and bone were the culprits, impacting in the airway or oesophagus. All but one patient had short ICU stay (≤3 days). Ingestion-associated adverse events can be protean and may necessitate PICU admissions. All age groups can be affected. Solids are usually associated with symptoms from local obstruction or suffocation, while fluids may be associated with systemic manifestations. Conclusion  Presentations were generally acute, dramatic and unmistaken. The majority of patients made prompt and uneventful recovery and had short PICU stay.     

The ‘picky eater’: The toddler or preschooler who does not eat

The majority of children between one and five years of age who are brought in by their parents for refusing to eat are healthy and have an appetite that is appropriate for their age and growth rate. Unrealistic parental expectations may result in unnecessary concern, and inappropriate threats or punishments may aggravate a child’s refusal to eat. A detailed history and general physical examination are necessary to rule out acute and chronic illnesses. A food diary and assessment of parental expectations about eating behaviour should be completed. Where the child’s ‘refusal’ to eat is found to be related to unrealistic expectations, parents should be reassured and counselled about the normal growth and development of children at this age.     

Reduced basal salivary cortisol in children with asthma and allergic rhinitis

Aim: Reduced basal cortisol is reported in allergic disease. We investigated if basal salivary cortisol levels were reduced in children with asthma or allergic rhinitis, controlling for inhaled corticosteroids (ICS) use. Methods: Morning and evening saliva of asthmatic children aged 7–12 years (n = 50) and that of controls (n = 52) were sampled. A total of 19 asthmatics and four controls had allergic rhinitis. Healthy children were controls without rhinitis. Of all, 14 asthmatic children used low, and 12 used moderate or high doses of ICS. Cortisol was analysed by radioimmunoassay. Results: Morning salivary cortisol median (95% CI) was lower in asthmatics (8.7 (7.1, 9.7)) compared with that in controls (10.4 (9.6, 11.8); p = 0.006), which was similar for evening cortisol levels. Regression analyses demonstrated that asthmatics using moderate or high doses of ICS had reduced morning salivary cortisol adjusted (for age and gender) odds ratio (aOR) (95% CI) (0.54 (0.37, 0.80); p = 0.002) and reduced evening cortisol aOR (0.09 (0.01, 0.6); p = 0.02) compared with that in healthy children. Asthmatics with rhinitis on no or low doses of ICS had reduced morning cortisol aOR (0.73 (0.56, 0.96); p = 0.02) compared with that in healthy children. Conclusion: Asthmatic children on moderate or high doses of inhaled corticosteroids had reduced salivary cortisol, but co‐morbidity of asthma and rhinitis was also associated with reduced cortisol levels.     

Psoriasis and non‐alcoholic fatty liver disease

Several recent studies have found an increased prevalence of non‐alcoholic fatty liver disease within psoriasis patients. The exact pathophysiological mechanisms behind these observations are unclear, but are likely related to the high prevalence of obesity and metabolic syndrome within this patient population. Chronic inflammation, mediated by either proinflammatory adipokines or skin‐derived cytokines, may contribute to fatty liver disease development by increasing insulin resistance which in turn promotes hepatic lipid accumulation. These same adipokines in addition to hepatic cytokines may act on the skin to influence psoriasis disease severity.