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Hypernatremia in congenital lamellar ichthyosis
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Editorial correspondence
Carvell JE, and Pearce DJ: Bilateral hydrothorax following internal jugular catheterization, Br J Surg 63:381, 1976.
Reply To the Editor: The association of hydrothorax and thoracic extravasation of fluid with central venous catheters for total parenteral nutrition has been known ~~and in most cases it occurs after several days or weeks following the placement of the catheter. It has been attributed to the use of hypertonic infusions, catheter stiffness, suboptimal position of the catheters-(in smaller veins), and slow vascular erosion with thrombus formation. However, none of these seem to have caused hydrothorax in our infant. Our patient received 5% dextrose solution without heparin during the first 24 to 48 hours of age. The catheter was not clotted and withdrawing of blood from the catheter became easy once the catheter was pulled out by 2 cm. Slow vascular erosion with thrombus formation is probably secondary to the irritating effect of prolonged infusion of hypertonic solutions in small veins with significantly low blood flow, which did not occur in our patient. Therefore, most likely the cause of hydrothorax in our patient is the obstruction of the pulmonary vein by the catheter, leading to the extravasation of infusing fluid and blood. Prakash B. Kulkarni, M.B.B.S., F.A.A.P. Rodney D. Dorand, M.D. Co-Directors Regional Neonatal Intensive Care Unit Baptist Medical Center 2105 East South Blvd. Montgomery, A L 36111 REFERENCES
I.
Knight L, Tobin J, and Heureux PL: Hydrothorax: A complication of hyperalimentation with radiologic manifestations, Radiology 111:637, 1976. 2. Groff DB: Complications of intravenous hyperalimentations in newborns and infants, J Pediatr Silrg 4:460, 1976. 3. Spriggs DW, and Brantley RE: Thoracic and abdominal extravasation. A complication of hyperalimentation in pediatric patients, Am J Roetgenol 128:419, 1977.
The Journal of Pediatrics November 1979
Hypernatremia in congenital lamellar ichthyosis T o the Editor: In the July, 1978~ issue of THE JOURNAL Jeanneau et al 1 described a case of seborrheic dermatitis with hypernatremic dehydration. We report the finding of hypernatremia, probably resulting from increased water loss through the affected skin, in two patients with another type of extensive skin disease, congenital lamellar iehthyosis. The first infant, weighing 2,550 gm on admission at 10 weeks of age, developed two episodes of hypernatremic dehydration. The second infant, weighing 2,400 gm on admission at 7 weeks of age, developed three episodes of hypernatremic dehydration. During these episodes serum sodium concentrations ranged between 151 and 165 mEq/1, and chloride levels between 120 and 128 mEq/l. Weight loss varied between 7 and 14% of body weight. The two infants had been treated with an emulsifying ointment (Ung. Cetomacrogol), which led to improvement in the skin condition within two days. The hypernatremia appeared when there had been a considerable increase in the area of thin, erythematous skin due to the shedding of the scales following treatment. No other cause for hypernatremic dehydration, such as diarrhea, vomiting, tachypnea, polyuria, fever, or high ambient temperature was evident. An explanation for this recurrent hypernatremia may lie in the finding of Jeanneau et al that there is excessive water loss through an extensive area of the affected skin. This effect would be particularly prominent in a small infant with a high surface/ weight ratio. Ben Zion GarO; M.D. Aryeh Metzker, M.D. Menachem Nitzan, M.D. Associate Professor of Pediatrics Department of Pediatrics Pediatric Dermatology Unit Beilinson Medical Centre ~]'el-A viv University Medical School Tel-A viv, Israel REFERENCE
1. Jeanneau R, Goodyear P, and Kaplan B: Hypernatremia in seborrheic dermatitis, J PEDIAXR93:148, 1978.
Erratum. In the March, 1977, issue of THE JOURNAL OF PEDIATRICS (90:4,82, 1977), in the article by Richard Stein, entitled "Chemotherapeutic response in fibromatosis of the neck," the second sentence of the second full paragraph on page 483 should have read, "The basic regimen was 12 weekly doses of vincrisfine, each 1.5 mg/m ~, given intravenously; five-day courses of actinomycin D totaling 0. 07A mg/kg, given intravenously every three months; and cyclophosphamide, 2.5 mg/kg/day, given orally and continuously." Erratum. In the September, 1979, issne of THE JOURNAL OF PEDIATRICS (95:415, 1979) in the article by David P. Jubelirer and Anne S. Yeager, entitled "Simultaneous recovery of ampicillin-sensitive and ampicillin-resistant organisms in Haemophilus influenzae type b meningitis," the third sentence in the frst paragraph should have read, "As shown in the Table, blood culture isolates were ampicillin resistent, whereas cerebrospinal fluid isolates were ampicillin sensitive. ""
Editorial correspondence
Carvell JE, and Pearce DJ: Bilateral hydrothorax following internal jugular catheterization, Br J Surg 63:381, 1976.
Reply To the Editor: The association of hydrothorax and thoracic extravasation of fluid with central venous catheters for total parenteral nutrition has been known ~~and in most cases it occurs after several days or weeks following the placement of the catheter. It has been attributed to the use of hypertonic infusions, catheter stiffness, suboptimal position of the catheters-(in smaller veins), and slow vascular erosion with thrombus formation. However, none of these seem to have caused hydrothorax in our infant. Our patient received 5% dextrose solution without heparin during the first 24 to 48 hours of age. The catheter was not clotted and withdrawing of blood from the catheter became easy once the catheter was pulled out by 2 cm. Slow vascular erosion with thrombus formation is probably secondary to the irritating effect of prolonged infusion of hypertonic solutions in small veins with significantly low blood flow, which did not occur in our patient. Therefore, most likely the cause of hydrothorax in our patient is the obstruction of the pulmonary vein by the catheter, leading to the extravasation of infusing fluid and blood. Prakash B. Kulkarni, M.B.B.S., F.A.A.P. Rodney D. Dorand, M.D. Co-Directors Regional Neonatal Intensive Care Unit Baptist Medical Center 2105 East South Blvd. Montgomery, A L 36111 REFERENCES
I.
Knight L, Tobin J, and Heureux PL: Hydrothorax: A complication of hyperalimentation with radiologic manifestations, Radiology 111:637, 1976. 2. Groff DB: Complications of intravenous hyperalimentations in newborns and infants, J Pediatr Silrg 4:460, 1976. 3. Spriggs DW, and Brantley RE: Thoracic and abdominal extravasation. A complication of hyperalimentation in pediatric patients, Am J Roetgenol 128:419, 1977.
The Journal of Pediatrics November 1979
Hypernatremia in congenital lamellar ichthyosis T o the Editor: In the July, 1978~ issue of THE JOURNAL Jeanneau et al 1 described a case of seborrheic dermatitis with hypernatremic dehydration. We report the finding of hypernatremia, probably resulting from increased water loss through the affected skin, in two patients with another type of extensive skin disease, congenital lamellar iehthyosis. The first infant, weighing 2,550 gm on admission at 10 weeks of age, developed two episodes of hypernatremic dehydration. The second infant, weighing 2,400 gm on admission at 7 weeks of age, developed three episodes of hypernatremic dehydration. During these episodes serum sodium concentrations ranged between 151 and 165 mEq/1, and chloride levels between 120 and 128 mEq/l. Weight loss varied between 7 and 14% of body weight. The two infants had been treated with an emulsifying ointment (Ung. Cetomacrogol), which led to improvement in the skin condition within two days. The hypernatremia appeared when there had been a considerable increase in the area of thin, erythematous skin due to the shedding of the scales following treatment. No other cause for hypernatremic dehydration, such as diarrhea, vomiting, tachypnea, polyuria, fever, or high ambient temperature was evident. An explanation for this recurrent hypernatremia may lie in the finding of Jeanneau et al that there is excessive water loss through an extensive area of the affected skin. This effect would be particularly prominent in a small infant with a high surface/ weight ratio. Ben Zion GarO; M.D. Aryeh Metzker, M.D. Menachem Nitzan, M.D. Associate Professor of Pediatrics Department of Pediatrics Pediatric Dermatology Unit Beilinson Medical Centre ~]'el-A viv University Medical School Tel-A viv, Israel REFERENCE
1. Jeanneau R, Goodyear P, and Kaplan B: Hypernatremia in seborrheic dermatitis, J PEDIAXR93:148, 1978.
Erratum. In the March, 1977, issue of THE JOURNAL OF PEDIATRICS (90:4,82, 1977), in the article by Richard Stein, entitled "Chemotherapeutic response in fibromatosis of the neck," the second sentence of the second full paragraph on page 483 should have read, "The basic regimen was 12 weekly doses of vincrisfine, each 1.5 mg/m ~, given intravenously; five-day courses of actinomycin D totaling 0. 07A mg/kg, given intravenously every three months; and cyclophosphamide, 2.5 mg/kg/day, given orally and continuously." Erratum. In the September, 1979, issne of THE JOURNAL OF PEDIATRICS (95:415, 1979) in the article by David P. Jubelirer and Anne S. Yeager, entitled "Simultaneous recovery of ampicillin-sensitive and ampicillin-resistant organisms in Haemophilus influenzae type b meningitis," the third sentence in the frst paragraph should have read, "As shown in the Table, blood culture isolates were ampicillin resistent, whereas cerebrospinal fluid isolates were ampicillin sensitive. ""