Özlem Tolu Kendir

Was not provided for this article.

Objective: Myxedema coma (MC) is a severe and rare clinical form of hypothyroidism that causes multiple organ failure and altered consciousness. The aim of reporting this case series is to evaluate the clinical presentation, diagnostic findings, and outcomes in pediatric patients diagnosed with MC. Materials and Methods: This article presents a case series of 8 patients diagnosed with MC between January 1, 2020, and October 31, 2024, at pediatric endocrinology department of the authors’ hospital. The clinical and laboratory data of the cases were obtained from the hospital records system, and the cases were scored using the diagnostic scoring system for MC. Results: The mean age was 10.36 ± 3.56 years, with a male-to-female ratio of 1:3. Four of the patients were diagnosed with hypothyroidism upon admission with MC, while the remaining 4 had a history of hypothyroidism but presented with MC due to non-compliance with treatment. The majority of patients presented with edema, rapid weight gain, lethargy, and other symptoms of hypothyroidism. Six patients had Hashimoto’s thyroiditis, 1 had thyroid hypoplasia, and 1 had thyroid aplasia. Laboratory tests revealed severely elevated thyroid-stimulating hormone (TSH) and low free thyroxine (fT4) and free triiodothyronine (fT3) levels. Six patients had elevated CK and myoglobin levels, indicating secondary rhabdomyolysis. Following levothyroxine (LT4) therapy, significant improvements were observed in muscle strength, thyroid function, and other clinical parameters. None of the patients required intensive care, and all recovered with 100% survival rate. Conclusion: Early diagnosis and appropriate thyroid hormone replacement therapy are crucial for reversing the metabolic abnormalities and preventing life-threatening complications. This study highlights the importance of timely intervention and emphasizes the need for strict adherence to thyroid hormone therapy in children with hypothyroidism. Cite this article as: Çetin K, Donbaloğlu Z, Bahar YF, et al. A rare endocrinological emergency in children with hypothyroidism: Clinical evaluation of cases presenting with myxedema coma. Turk Arch Pediatr. 2025;60(5):474-482.

Salbutamol Plus Mask Oxygen Versus HFNC in Bronchiolitis - Journal of Pediatric Emergency and Intensive Care Medicine

Objectives Noninvasive capnography (NICG) devices can measure oxygen saturation, end-tidal carbon dioxide (EtCO2), respiratory rate, heart rate values and integrated pulmonary index (IPI). This study aimed to evaluate patients who were monitored using NICG for various indications in a pediatric emergency department and to determine its contribution to patient management in the pediatric emergency department (PED). Methods In this study, children aged <18 years who had been monitored with a NICG at the PED in our university between August 2018-May 2019 were evaluated. Of them 48 patients' file records and monitored capnography parameters such as heart rate, respiratory rate, blood pressure, capillary refill time, Glasgow Coma Score, SpO2, EtCO2, IPI recorded in the forms were reviewed. Results Patients most often presented to the emergency room due to seizures (35.4%), change in consciousness (22.9%), other neurological reasons (18.8%) with %50 were female. Seizure treatment(16.7%), circulatory–respiratory support(16.7%), and antiedema treatments(6.3%) were required for 39.5% patients as life-saving interventions, and 72.9% patients were hospitalized. Patients with low IPI(<8) values at the beginning and decreasing IPI (<8) measurements within monitoring period needed more life-saving treatments(p=0.005 and p=0.001, respectively). Low IPI values of the patients during monitoring showed a significant difference in the decision to be hospitalized(p=0.048). Conclusions The results of the present study indicate that monitoring with NICG in the pediatric emergency room can be an important early indicator in establishing clinical prediction. The study particularly points out that the IPI value can be a guide in decisions regarding life-saving treatment and hospitalization. Among the capnographic data of these patients who had a change in consciousness IPI values those measured at the beginning and within the monitorizarion period showed a significant correlation with low GCS (<8) (r=0.478, p=0.001 and r=0.456, p=0.02, respectively). Prospective comprehensive large scale studies are needed to examine the use of NICG and IPI in routine PED practice for various indications.

OBJECTIVES: We aimed to compare the demographic and clinical characteristics between pediatric cardiac arrest patients treated in Gaziantep at South-eastern Anatolian region and Izmir at Aegean Shore. MATERIALS And METHODS: We retrospectively reviewed sociodemographic characteristics, laboratory parameters, and clinical outcomes of pediatric patients that underwent cardiopulmonary resuscitation due to prehospital cardiac arrest at two pediatric emergency departments in Izmir Hospital of Health Sciences University and Gaziantep Cengiz Gökçek Kadın Doğum ve Çocuk Hospital of Health Ministry between August 2017 and August 2018. RESULTS: The present study included 188 patients (112 patients from Gaziantep and 76 patients from Izmir). All patients arrived at the hospital through emergency medical services. The median age was lower (14 days vs. 15 months; P < 0.001), and the proportion of Syrian refugees was higher in patients from Gaziantep (78.6% vs. 7.9%; P < 0,001). In both centers, respiratory failure was the most common etiology. In patients from Gaziantep, pH levels were lower (median: 7.10 vs. 7.24), and lactate levels were higher (median: 6 mmol/L vs. 3.6 mmol/L; P < 0.001). The mortality rate was higher among patients from Gaziantep (27.7% vs. 7.9%; P = 0.001). CONCLUSIONS: The rate of Syrian refugees among children who were brought to emergency department due to pre-hospital cardiac arrest was much higher in Gaziantep compared to Izmir. Syrian children were significantly younger and had more severe tissue hypoxia, resulting in a higher mortality rate.