Rhabdomyolysis is a process of muscle destruction that can present with varying
clinical manifestations. In pediatric patients, its main etiology is infectious
diseases. We present a previously healthy adolescent who was admitted to our
emergency department with a four-day history of myalgia, muscle weakness and
dark urine. At presentation, she was dehydrated. Blood analysis revealed acute
renal failure and increased muscular enzymes.She was transferred to our pediatric intensive care unit. Medical therapies for
correction of dehydration and the ionic and metabolic consequences of renal
failure were performed. Due to oliguria, renal replacement therapy was
initiated. An etiological investigation revealed a beta-oxidation defect.
Metabolic diseases are a known cause of rhabdomyolysis. Muscular destruction
should be diagnosed early in order to avoid its potential consequences.
Generally, the treatment of rhabdomyolysis is conservative, although in some
situations, a more invasive approach is needed.
A questionnaire survey of 150 last term dental students from four dental schools was performed to delineate their current opinion with regard to the use of epinephrine-containing anesthetic solutions for dental procedures in cardiac patients. The students provided their opinion as "contraindicated" or "not contraindicated" regarding the use of these solutions in eight cardiac patients with either stable or unstable heart diseases including ischemic heart disease, arrhythmia, hypertension, and heart failure. We found an overall 77% rate of right answers among all students. Mistakes occurred more frequently when treating patients with ischemic heart disease (68% of right answers). Although vasoconstrictors may offer many advantages and are not contraindicated to the majority of cardiac patients, graduating dental students sometimes do not comply with current guidelines.
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