A dangerous case of colic: anomalous left coronary artery presenting with paroxysms of irritability.
Division of Pediatric Cardiology, Children's Hospital of Philadelphia, PA 19104, USA.
Anomalous left coronary artery originating from the pulmonary artery (ALCAPA) is a rare, but potentially lethal, cause for irritability in infancy. We present the case of a 12-week-old male infant who was managed as a colic patient for several weeks before the diagnosis of ALCAPA was established. A brief review of previous case reports demonstrated that paroxysms of irritability can be a presentation of this disorder. In the majority of cases the manifestations of ALCAPA can be differentiated from other diseases known to cause a infant to be colicky.
Metoclopramide toxicity in an infant.
Batts KF. Munter DW.
Emergency Medicine Department, Naval Medical Center, Portsmouth, Virginia 23708, USA.
Metoclopramide (4-amino-5-chloro-N-2-methoxybenzamide) is a central and peripheral acting dopamine antagonist. It also stimulates motility in the upper gastrointestinal tract and increases lower esophageal sphincter pressure. In the pediatric population, it is used extensively as an antiemetic and in the treatment of gastroesophageal reflux disease. The case of a six-month-old infant who was accidentally overdosed with 24 mg (3 mg/kg) of metoclopramide within a nine-hour period is presented. The patient demonstrated toxic extrapyramidal effects. There have been multiple early reports in the European literature of acute extrapyramidal reactions in the pediatric population, but no reports of toxicity exist in the current emergency medicine literature.
Priapism: an unusual presentation of appendicitis.
Division of General Pediatrics, the University of Toronto, and The Hospital for Sick Children, Ontario, Canada.
Priapism, a persistent abnormal penile erection that is painful and unassociated with sexual interest, is known to be associated with a wide range of etiologies in children. This is a report of a case of appendicitis in an eight year old presenting with priapism. There is no mention in the pediatric literature of priapism associated with appendicitis. Possible appendicitis should be included in the differential diagnosis of priapism.