May 2016 PDF uploaded for the bank holiday

Reintroduction of egg this month with thanks to the BSACI, benign acute childhood myositis, NICE on iv fluids plus a couple of links on when not to use this guidance and a comparison of algorithms for children with a non-blanching rash.  Do leave comments below.

2 thoughts on “May 2016 PDF uploaded for the bank holiday

  1. Hi Julia

    Benign Acute Childhood Myositis – share with you some facts and my personal practice.

    · Very common in children and benign. Many have a bit of aches and pains, not necessarily need a blood test, many stayed in the community and not referred.

    Flu virus is a common associated agent, but all viruses could do it.
    Eat and drink, IV fluids really not necessary, reassure.

    · A note on Rhabdomyolysis

    If CK is high with muscle pain, acute onset, please ask for a urine dipstick.
    Urine colour may not be a sensitive marker and very subjective.
    Myoglobin will turn urine dipstick positive on the ‘blood’ section.
    In acute rhabdomyolysis, there is myoglobinuria, urine dipstick will show 4+ of blood. CK will be very high> 10000
    Adolescent with good muscle bulk could have a very high CK,> 100000, last case I had CK 240000!
    Hyperhydrate with IV + oral fluids twice the normal maintenance at least if no pre-existing heart problem.
    This is to prevent myoglobin clogging the renal tubules, lead to renal failure
    This is an unusual general paeds emergency condition, diagnosis can be delayed.
    GOSH nephrology will not take the patient unless there is renal failure.
    if there is renal failure, it means the diagnosis is delayed and failure to initiate hyper-hydration treatment early to prevent complications

    · Do we need to repeat CK in 3-4 weeks to ensure complete resolution of the condition?

    It is a clinical judgement. If symptoms have completely resolved and clinically well, probably no.
    The indication to repeat is when the diagnosis is uncertain, ie if symptoms persists, and to look for evidence dermatomyositis/ overlap syndrome.

    Paediatric Consultant, Bartshealth NHS Trust

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