scholarly journals Food Protein-Induced Enterocolitis Syndrome Causing Hypovolemic Shock and Methemoglobinemia

2018 ◽  
Vol 2018 ◽  
pp. 1-4
Author(s):  
Stefan W. Malin ◽  
Riad Lutfi ◽  
Matthew L. Friedman ◽  
Alicia M. Teagarden
Keyword(s):  
Methylene Blue ◽  
Metabolic Acidosis ◽  
Fluid Resuscitation ◽  
Hypovolemic Shock ◽  
Dietary Change ◽  
Recent Change ◽  
Food Protein ◽  
Healthy Male ◽  
Dietary History ◽  
Life Saving

A 5-week-old previously healthy male presented with vomiting and diarrhea leading to hypovolemic shock and profound metabolic acidosis. He was subsequently found to have severe methemoglobinemia. The acidosis and shock improved with fluid resuscitation and methemoglobinemia was successfully treated with methylene blue. An extensive workup, including evaluations for infectious and metabolic etiologies, was unremarkable. However, a detailed dietary history revealed a recent change in diet, supporting a diagnosis of food protein-induced enterocolitis syndrome (FPIES). We present this case to highlight the importance of considering FPIES in an infant with vomiting and diarrhea, in the setting of a recent dietary change, leading to profound dehydration, metabolic acidosis, and methemoglobinemia. Diagnosis of FPIES, although difficult to make and one of exclusion, can be potentially life-saving.

scholarly journals Fluids of the Future

2021 ◽  
Vol 7 ◽  
Author(s):  
Thomas H. Edwards ◽  
Guillaume L. Hoareau
Keyword(s):  
Acute Care ◽  
Fluid Resuscitation ◽  
Large Scale ◽  
Large Temperature ◽  
Ongoing Research ◽  
Military Research ◽  
Animal Data ◽  
Life Saving ◽  
The Future ◽  
Significant Burden

Fluids are a vital tool in the armament of acute care clinicians in both civilian and military resuscitation. We now better understand complications from inappropriate resuscitation with currently available fluids; however, fluid resuscitation undeniably remains a life-saving intervention. Military research has driven the most significant advances in the field of fluid resuscitation and is currently leading the search for the fluids of the future. The veterinary community, much like our civilian human counterparts, should expect the fluid of the future to be the fruit of military research. The fluids of the future not only are expected to improve patient outcomes but also be field expedient. Those fluids should be compatible with military environments or natural disaster environments. For decades, military personnel and disaster responders have faced the peculiar demands of austere environments, prolonged field care, and delayed evacuation. Large scale natural disasters present field limitations often similar to those encountered in the battlefield. The fluids of the future should, therefore, have a long shelf-life, a small footprint, and be resistant to large temperature swings, for instance. Traumatic brain injury and hemorrhagic shock are the leading causes of preventable death for military casualties and a significant burden in civilian populations. The military and civilian health systems are focusing efforts on field-expedient fluids that will be specifically relevant for the management of those conditions. Fluids are expected to be compatible with blood products, increase oxygen-carrying capabilities, promote hemostasis, and be easy to administer in the prehospital setting, to match the broad spectrum of current acute care challenges, such as sepsis and severe systemic inflammation. This article will review historical military and civilian contributions to current resuscitation strategies, describe the expectations for the fluids of the future, and describe select ongoing research efforts with a review of current animal data.

scholarly journals Metabolic acidosis as Food Protein Induced Enterocolitis Syndrome (FPIES) onset in a newborn

2018 ◽  
Vol 44 (1) ◽  
Author(s):  
Antonella Peduto ◽  
Mario Rocca ◽  
Cinzia De Maio ◽  
Federica Gallarotti ◽  
Giulia Pomero ◽  
...  
Keyword(s):  
Metabolic Acidosis ◽  
Food Protein

Liquorice and soy sauce, a life-saving concoction in a patient with Addison's disease

2007 ◽  
Vol 44 (4) ◽  
pp. 397-399 ◽  
Author(s):  
H Cooper ◽  
B Bhattacharya ◽  
V Verma ◽  
A J McCulloch ◽  
W S A Smellie ◽  
...  
Keyword(s):  
Addison’S Disease ◽  
Soy Sauce ◽  
Common Salt ◽  
Addison's Disease ◽  
Dietary History ◽  
Subsequent Investigation ◽  
Life Saving ◽  
History Of ◽  
Glucocorticoid Action

Addison's disease is a relatively common disorder to endocrinologists, but is rare and potentially fatal when presenting acutely. Treatment now involves replacement of glucocorticoids and mineralocorticoids with synthetic compounds, although historically patients took common salt and plant-based preparations. We describe the case of a 42-year-old woman who self-treated undiagnosed Addison's disease for several years with soy sauce and liquorice sticks. She presented with a four-week history of decreased energy, malaise and postural dizziness. Our patient described an unusual diet of liquorice sticks and soy sauce, consuming around 46 g of salt per week. There was a family history of Type 1 diabetes mellitus. Physical examination was unremarkable, although subsequent investigation confirmed Addison's disease. Liquorice provided glycyrrhizic acid and glycyrrhetinic acid, which act on 11-beta hydroxysteroid dehydrogenase enzymes. In this case, the net effect was potentiation of glucocorticoid action on renal mineralocorticoid receptors in the context of failing adrenocortical steroid production. The case highlights the importance of taking a dietary history to aid diagnosis.

Prolidase deficiency in an infant with an incidental finding of methaemoglobinaemia

2021 ◽  
Vol 14 (11) ◽  
pp. e244155
Author(s):  
Chern Yan Tan ◽  
Easwari Kothandaraman ◽  
Arunabha Ghosh
Keyword(s):  
Methylene Blue ◽  
Metabolic Acidosis ◽  
Exome Sequencing ◽  
Incidental Finding ◽  
Milk Allergy ◽  
High Dependency Unit ◽  
Prolidase Deficiency ◽  
High Dependency ◽  
Hydrolysed Formula ◽  
Peptidase D

A 4-week-old boy presented to the hospital with symptoms of diarrhoea and vomiting initially thought to be due to cow’s milk allergy. He was discharged with extensively hydrolysed formula. The patient represented with worsening of symptoms with metabolic acidosis and was screened and treated for sepsis. However, his condition deteriorated further and he developed methaemoglobinaemia. He was transferred to the high dependency unit and was given two doses of methylene blue. Further investigations were carried out, including rapid trio exome sequencing, which identified a homozygous pathogenic Peptidase D (PEPD) variant (c.978G>A, p.(Trp326*)). This was consistent with a diagnosis of prolidase deficiency.

Fluid Resuscitation of Hypovolemic Shock: Acute Medicine's Great Triumph for Children

2006 ◽  
Vol 32 (7) ◽  
pp. 958-961 ◽  
Author(s):  
Joseph A. Carcillo ◽  
Robert C. Tasker
Keyword(s):  
Fluid Resuscitation ◽  
Hypovolemic Shock
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