Hemorrhagic shock and encephalopathy syndrome – the markers for an early HSES diagnosis
| Autor: | Satoru Miyamoto, Arito Kaji, Akira Yoshimoto, Tetsushi Kubota, Akihiro Fuke, Takeshi Yoshida, Masanori Kan, Toshinori Miyaichi, Miho Tsuruwa, Ichiro Kuki, Hiroshi Rinka, Dai Miyazaki, Hideki Arimoto, Masashi Shiomi |
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| Jazyk: | angličtina |
| Rok vydání: | 2008 |
| Předmět: |
Male
Resuscitation Pathology medicine.medical_specialty Time Factors Encephalopathy Brain Edema Shock Hemorrhagic Cerebral edema Hemoglobins Predictive Value of Tests Edema medicine Coagulopathy Humans Vasoconstrictor Agents Aspartate Aminotransferases Pediatrics Perinatology and Child Health Child Creatine Kinase Brain Diseases Platelet Count business.industry lcsh:RJ1-570 Infant Alanine Transaminase Metabolic acidosis lcsh:Pediatrics Syndrome Prognosis medicine.disease Child Preschool Shock (circulatory) Anesthesia Pediatrics Perinatology and Child Health Fluid Therapy Female Base excess Hypotension medicine.symptom Tomography X-Ray Computed business Biomarkers Research Article |
| Zdroj: | BMC Pediatrics, Vol 8, Iss 1, p 43 (2008) BMC Pediatrics |
| ISSN: | 1471-2431 |
| Popis: | Background The hemorrhagic shock and encephalopathy syndrome (HSES) is a devastating disease that affects young children. The outcomes of HSES patients are often fatal or manifesting severe neurological sequelae. We reviewed the markers for an early diagnosis of HSES. Methods We examined the clinical, biological and radiological findings of 8 patients (4 months to 9 years old) who met the HSES criteria. Results Although cerebral edema, disseminated intravascular coagulopathy (DIC), and multiple organ failure were seen in all 8 cases during their clinical courses, brain computed tomography (CT) scans showed normal or only slight edema in 5 patients upon admission. All 8 patients had normal platelet counts, and none were in shock. However, they all had severe metabolic acidosis, which persisted even after 3 hours (median base excess (BE), -7.6 mmol/L). And at 6 hours after admission (BE, -5.7 mmol/L) they required mechanical ventilation. Within 12 hours after admission, fluid resuscitation and vasopressor infusion for hypotension was required. Seven of the patients had elevated liver enzymes and creatine kinase (CK) upon admission. Twenty-four hours after admission, all 8 patients needed vasopressor infusion to maintain blood pressure. Conclusion CT scan, platelet count, hemoglobin level and renal function upon admission are not useful for an early diagnosis of HSES. However, the elevated liver enzymes and CK upon admission, hypotension in the early stage after admission with refractory acid-base disturbance to fluid resuscitation and vasopressor infusion are useful markers for an early HSES diagnosis and helpful to indicate starting intensive neurological treatment. |
| Databáze: | OpenAIRE |
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