Introduction and aim Cardiac murmurs are reported in 50–90% of children at some time in their life, but only 1% are pathological. It is widely questioned whether performing echocardiograms on these children with asymptomatic murmurs is cost-effective or not. We designed this study to survey parents of children who had echocardiograms for asymptomatic heart murmurs which then proved to be benign. Methods All new referrals for ‘asymptomatic heart murmurs’ to the paediatric cardiac clinic, run by a paediatrician with cardiology expertise, over a one-year period were reviewed. The parents of children with normal echocardiograms were requested to answer a questionnaire that elicited their experience of the echocardiogram and its impact on their concerns. Permission for this study was obtained, and consent sought from contacted parents. Results 166 new patients attended the clinic during the study period, 67/166 were for asymptomatic heart murmurs. 58/67 of these patients had normal echoes. Among the 58patients, 51 were contacted by telephone for the survey (Table 1). None of these children had any repeat consultations for the murmur, and parents were convinced that the echo gave them the reassurance that they badly needed. Abstract G241(P) Table 1 Salient results from the survey (n = 51) Conclusions Our study concluded echocardiograms provide parents with a satisfactory conclusion to the consultation. This may be a cost-effective method in reducing repeat consultations for the same concerns.
Aim To evaluate current practice in requesting salicylate levels in children presenting with intentional overdose. Background Intentional overdose is a common presentation in children's emergency departments but the pattern of medications taken has changed over time. Over the last two decades use of aspirin (salicylate) has markedly reduced since recognition of Reye's Syndrome in children. Toxbase and NPIS advise salicylate levels are not required unless there is admission of ingestion, symptoms of salicylate toxicity or in the unconscious patient. It was noted that it remains common practice to check salicylate levels in children with intentional overdose. Methods A retrospective review of all children presenting with intentional overdose at a busy two site acute trust. Case note and blood results review of all children coded as poisoning between July -December 2012, excluding children with accidental overdose. Results There were 59 episodes of intentional overdose with 53 females and 6 males. The average age was 14yrs (11 -16yrs). 73% (43) of the patients were asymptomatic. The most common drug taken was paracetamol (46%), followed by ibuprofen (20%) and cocodamol (11%). Only 2 patients (3%) admitted taking salicylate. The majority of initial blood tests were taken in the emergency department (71%). 83% (49) had salicylate levels measured and only 4% (2) had abnormal levels. Both of these patients had admitted salicylate ingestion. No patients who denied salicylate ingestion were found to have raised levels. Salicylate levels were deemed appropriate and useful in 4 (8%) patients due to history or symptoms. It was also observed that there was frequent requesting of a wide range of unnecessary blood tests including CK, FBC and CRP.Conclusion There is considerable over testing of salicylate levels in children with intentional overdose. Our results found the test appropriate in only 4 (8%) patients. The laboratory test itself is relatively cheap however, in combination with other unnecessary tests, the cumulative cost is significant. We advise improved education as to the indications for salicylate levels as part of aiming to reduce unnecessary investigations and costs in children's emergency department. Aim To develop a paediatric cardiac murmur guideline for a Children's emergency department (CED), following mismanagement of 2 cases of heart murmurs in children. Currently there is no national guideline in place. Methods Electronic databases Medline, Embase, Cochrane Cinahl, Psycinfo, Amed, British nursing index, DARE and CENTRAL were searched using title/abstract terms and subject headings: heart/cardio/cardia/murmur/sound AND diagnosis/ assessment/evaluation/examination. Results were limited to children aged 0-18 years and no limitations placed on date or language. The results were exported on to Mendeley workstation and analysed. G92(P)PAEDIATRICAbstract G92(P) Figure 1 Neonatal murmur algorithm Abstracts A38Arch Dis Child 2015;100(Suppl 3):A1-A288
Hyponatremia, unless associated with extracellular fluid volume expansion, is an uncommon paediatric electrolyte imbalance. We report an infant presenting with chronic hyponatremia suggestive of a syndrome of inappropriate secretion of antidiuretic hormone (SIADH); however without ADH secretion. In this case, a gain-of- function of AVPR 2 was found to be responsible for a SIADH-like state. Only very few cases have been reported in the literature.A healthy 19 month old presented to his local hospital with a tonic-clonic seizure, demonstrating a sodium of 119 mmol/L. A few months prior, hyponatraemia was noted in the context of a lower respiratory tract infection, treated with a short course of sodium chloride supplementation with no further follow-up. Recently he was diagnosed with cow’s milk protein allergy. His mother described him being a poor water drinker with infrequent wet nappies.He was developing appropriately with no significant family or social history. He examined normally. Over 48 hours, he received six hypertonic (2.7%) saline boluses. His sodium remained refractory (116–122 mmol/L) and nephrology input was sought. Results showed serum osmolality of 250 mosml/l, urinary osmolality of 520 mosml/l and urinary sodium of 171 mmol/L. Chest radiograph was normal.On transfer to tertiary nephrology services he was normotensive with unremarkable examination.Investigations demonstrated:Abstract G24(P) Table 1 Paired results Blood Urine Sodium 119 mmol/L 137 mmol/L Potassium 5.3 mmol/L 12.4 mmol/L Creatinine 8 umol/L 0.9 mmol/L Osmolality 252 mosm/l 387 mosml/l *Paired results showed fractional sodium excretion of 1%CT head, renal ultrasound and renin/aldosterone, cortisol, thyroid function were normal. Paired plasma and urine results suggested syndrome of inappropriate antidiuresis (SIADH). No secondary causes were apparent; thus nephrogenic syndrome of inappropriate antidiuresis (NSIAD) caused by gain of function mutation in AVPR2 was postulated.Analysis of the AVPR2 gene confirmed this x-linked dominant disorder (mutation (c.409C>T)). Familial testing revealed his mother as a carrier, with subtle retrospective symptoms.We suspect the patient had chronic asymptomatic hyponatremia, acutely exacerbated by full switchover to oat milk in view of allergies, which has little protein content. This lowered his tubular osmotic load and coupled renal water loss.In conclusion, NSIAD can mimick SIADH and should be considered if no secondary cause found combined with a positive family history; though this was initially lacking in our case. This is the first case we have diagnosed in our centre.
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