Background Although hyperglycemia and pancreatitis are known side effects of L-asparaginase, both contributing to the development of diabetic ketoacidosis (DKA) is unfamiliar in literature. Case presentation We report a case of an adolescent girl, recently diagnosed with ALL, who presented with pain in abdomen and breathing difficulty following chemotherapy with L-asparaginase. On subsequent evaluation, she was found to have high anion gap metabolic acidosis, hyperglycemia and ketonuria. Ultrasonogram showed bulky pancreas. DKA was managed with fluid correction and insulin infusion. Pancreatitis was managed conservatively. She recovered completely with resolution of symptoms and without any major adverse events despite having such severe complications. Conclusion We conclude that the combination of DKA and pancreatitis is a rare occurrence with significant morbidity and mortality. We recommend a close monitoring of blood glucose levels for hyperglycemia as well as a high index of clinical suspicion for pancreatitis in patients with ALL receiving L-asparaginase.

No abstract

Background Water and electrolyte disorders commonly encountered in children post-surgery involving hypothalamus and posterior pituitary, are central diabetes insipidus, syndrome of inappropriate secretion of anti-diuretic hormone and cerebral salt wasting disease. Delayed diagnosis and inadequate management of such cases may lead to worsened neurological outcomes with a high mortality rate. Case presentation Here we report the case of a 7-year-old girl who underwent surgical resection of a craniopharyngioma, following which she initially developed central diabetes insipidus. However, later on in the course of her illness she developed symptomatic hyponatremia with natriuresis which was diagnosed to be due to cerebral salt wasting disease. This combination of central diabetes insipidus and cerebral salt wasting syndrome is a rare occurrence and poses a diagnostic challenge. Diagnosis and management can be even more difficult when these conditions precede or coexist with each other. Conclusion In such cases development of hyponatremia should always prompt consideration of unusual causes like cerebral salt wasting disease in addition to the classically described syndrome of inappropriate secretion of anti-diuretic hormone. Hence, a thorough knowledge of these disorders along with intensive monitoring of fluid and sodium status is critical for timely diagnosis and management of these patients.

A severe medical emergency that poses a life-threatening risk is envenomation from a snake bite. Among the several snake families, krait bites are known to result in neurological symptoms, including ptosis, headache, and sweating. A 12-year-old adolescent boy who had been bitten by a krait appeared in this instance. The patient showed neurological symptoms after receiving anti-snake venom (ASV). He had three rounds of ASV and made a full recovery. To the best of our knowledge, there have not yet been any reports of this kind of delayed neurological signs after a krait bite, despite getting ASV in the adolescent population.

A BSTRACT Guillain–Barré syndrome (GBS) is an immune-mediated acute inflammatory polyradiculoneuropathy and it is the most common cause of acute flaccid paralysis worldwide. There are some rare variants of GBS, which may be easily missed unless suspected. Here we present a case of GBS presenting as isolated acute bulbar palsy. A 10-month-old infant, known case of tricuspid atresia with pulmonary stenosis, presented with left-sided lower motor neuron type of facial palsy and palsy of bilateral glossopharyngeal and vagus nerve of 2 weeks’ duration. On detailed neurological examination, motor and sensory system were normal. Nerve conduction study showed demyelinating motor neuropathy and hence the diagnosis of GBS was made. To the best of our knowledge, no case of isolated bulbar palsy due to GBS in infancy has been reported.

Congenital maxillomandibular synostosis is a rare congenital deformity associated with fusion between maxilla and mandible. We report a case of a five years old child who presented with inability to open her mouth since birth. Similar history was present in the elder sister. Diagnosis of familial congenital synostosis was made and was surgically managed.

Background: The aim of the study was to evaluate whether light-emitting diode (LED) phototherapy is as efficacious as compact fluorescent tube (CFT) phototherapy for the treatment of non-hemolytic jaundice in healthy term and late preterm neonates.Methods: Study design was open label randomized controlled trial conducted at tertiary care NICU. Healthy term and late preterm neonates with non-haemolytic jaundice included in the present study. Intervention was double-surface LED or CFT phototherapy. Primary outcome variable was duration of phototherapy.Results: A total of 60 neonates were randomized to receive LED (n=30) or CFT (n=30) phototherapy. The baseline demographic and biochemical variables were similar in the two groups. The median duration of phototherapy (Mean±SD) in the two groups was comparable (26.7±7.0) h vs (24.8±6.05) h, P=0.0.241). The rate of fall of serum total bilirubin (STB) during phototherapy in initial 6 hours was significantly more LED group (n=30), 3.43±0.65 versus (n=30) 2.22±0.55 with P-value of <0.001.Conclusions: LED and CFT phototherapy units were equally efficacious in the management of non-haemolytic hyperbilirubinemia in healthy term and late-preterm neonates.  Side effects were rare, comparable in the two groups and included only rash.

No abstract