Microsoft word - beware of usual use of medication in children

BEWARE OF CASUAL USE OF MEDICATION IN CHILDREN

Lip service cause free, but with a lot of risk and potential danger!
Because of its vital role as an excretory organ the kidneys are responsible for the eliminate and metabolism of many foreign organic compound, including pharmacologic agents. Unfortunately there agents reach the kidneys and bladder before excretion into service. Unfortunately, while performing its role as an excretory and metabolic organ, the kidney tissues undergo anatomic and functional damage as a result of dry induced toxicity. Factors that contribute to the district susceptibility of the kidneys to injury, include :- exposure to potentially harmful compounds new borns and preterms with immure kidney issue and function extended and sustained exposure to toxics Both the tubules and glomereelar dysfunction can occur. Vasoconstriction of renal vessels, endothelical cell damage, Redox recycling with damage to antioxidant defence mechanisms of Renal cells (dysfunction of cell proteins of P-450, GSH etc.). Nephrotoxicity from antibiotics
High concentration of antibiotics in kidneys predispose them to chronic damage. Drugs- Aminoglycosides (Geutaauyan, Amikacin) NSAIDS - Ibubrufen, Indomethcin, Antiviral – Acyclovir, Ganciclovir Cyclosporine Radio Contrast Agents Anti Cancer Drugs Types of Revel Damage Induction of Myolysis or Hemolytic Anaemias. Chinese herb nephropathy – These medicines can cause Acute Renal Failure, Chronic
Renel Failure, Cancers etc.
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Enviornmental Toxics – organic solvecets – ethylene glycol, pollution and toxins due to industrial and vehicle pollution. Heavy Metals – Lead, mercury, gold, copper, arsenic are contained in many herbal and alternative line of medications. These cause chronic organ damage of kidneys, liver, brain etc. OCT (over the counter therapy ) – this practice should be disallowed to minimize the misuse of any drug. Drugs have been labeled alphabetically to give the potential risks of these drugs but the pharmacies prescribe many medications on their own. A pharmacists or a lay man in a drugs store can not and should not prescribed medicines to any patient, even a child. It is also noticed that old outdated prescriptions are reused by patient and pharmacies. All medical conditions of the same system may not have the same line of treatment. Self Treatment – Self Treatment is potentially dangerous, and misuse of wrong and top of the line drugs can harm a child. Combination of antibiotics and antipyretics can cause lethal harm. Tele Vision – projecting wrong advertisements – “Grandma Nuskas” can give a wrong message to viewers. Telephonic Consultation can also be dangerous since the doctor may not get a correct picture without seeing a child. Over use and misuse of irrational drugs precipitate drug resistance and many drugs become ineffective. Dr. Sanjeev Bagai
Medical Advisor & Director, HOD
Paediatrics Department
Rockland Hospital


Renal Calculi Disease
Case Study a two month old small infant presented with failure to thrive, vomiting and
recurrent infections, and weight loss. After comprehensive tests and diagnosis, the child
was diagnosed to have a Renal tabular defect (d-RTA), and had bilateral nephrocalcinosis
(Renal stones in both kidneys). With proper treatment, the baby’s metabolic condition
was controlled and long term permanent damage to kidneys prevented.
Renal stones occurs in all parts of Genio-Urinary Tract, 97% occurs in the upper tracts
(Parenchyma, Pelvis, Ureters), 3% are localized in the bladder and urethra. The major
constituents are calcium oxalate 65% uric acid, 15% Struvite, 7% carbonate and
Ohapatite 5%, others - cystine, Ammonia, urate, xanthine, 2,8diHydroxyadanine, protein
etc.
Urinary stones (urolithiasis) is increasingly recognized in patients, with a variety of
clinical settings.
Incedence
110/1 lakh population/year in 10-19yr. age Urine Stone Formation – factors include age, sex, profession, mentality,
nutrition, constitution, climate, race, inheritance leading to ------ abnormal renal morphology + disturbed urine flow + UTI + Metabolic abnormality + genetic factor leading to ------------ Increased excretion of stone constituents + decreased excretion of stone forming inhibitors of crystallization leading to ---------- Physicochemical change in state of super saturation leading to --------– abnormal (crystalluria + aggregation + growth ) leading to -------- renal stone.
Associated Diseases : Disturbances of (a) calcium metabolism – pHPT, dRTA, Batters,
NF, Wilson’s, medullary sponge kidney, osteoporoses, immobilization, sarcoidosis,
osteolytic metastasis, plasmocytoma (b) Oxalate metabolism – primary hyperoxaluria
(1&2), Crohn’s ulcerative colitis (c) uric acid metabolism – anemia, neoplasia,
intoxication, MI, irradiation, chemotherapy, gout, Lesh-Nyhan synd, Acute and Chronic
Renal Failure, metabolic acidosis (d) infections – UTI, (e) Medication – Uricosurics,
iuretics, analgesics, high dose vitamin A, D & C.
Symptoms & Signs – varied, hidden, subtle
Renal colic (Pain, sweating, abnormal BP, abdominal distension, Vomiting, oligo-anuria,
dysuria, urgency, fever, sepsis, haematuria, etc.)
Obstructive pyelonephritis
Diagnosis : Urine – Routine and Culture, Spot (Ca, Urea, Creatinine, Albumin, Uric
acid, P, Na, K, oxalate, citrate, Mg, NH3, cystine) with require 24 hours excretions,
Radiology – Plain x-ray, USG, IVP, RGP, renal nuclear scans, MCU, Blood –
Haemogram, Clotting profile, U/E/C, Ca, P, Alk. Phos, LFT, Uric acid, ABG, PTH.
There are specific normograms for blood and specially urine for urinary excretion values,
which are age dependent.
Infection induced renal calculi.
Rare in paediatrics, even rarer in infancy, staghorn calculi in early infancy vary rare. M >
F, caused by urea splitting bacteria in recurrent Urinary Infections with abnormal super
saturation and crystalluria, which causes alkaline urine these stones can contain calcium,
Mg, NH3, P and matrix.
Treatment of Infection induced renal calculi.
1.
Prophylaxis, urine PH modification, diet advise, watch for medication, which is nephrotoxic or stone causing, metabolic abnormality treatment eg. Vitamin B6, Allopurinal, indomethacin, K – supplementation, hydrochlrothiazie, etc. Urine stone analysis (X-ray diffraction, spectrometry) Surgical treatment – Open surgery, Endoscopic, PCNL, URS, Lithotripsy etc.
Dietary Modification helps in controlling kidney stone disease – diets high in cereals, low
in animal protein and ketogemic diets often cause stones.
Suggested therapy for use lithiasis:-

For Hypercalciuria - reduction in dietary sodium, Reduction in Thiazide use, add potassium citrate /phosphates For Hyperoxaluria - low oxatates, add phosphates, magnesium and For Hyperuricosuria - Alkalinization of urine, with alloperinol. - For cystinuria - Alkalinization of urine, reduction of dietary
Summary – early diagnosis and treatment of peadiatric kidney stone disease prevents
chronic kidney failure and end organ damage. Specific centres with correct therapy are
available in Delhi for treating even the smallest of infants with this disease.

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