INTENSIVE THERAPY OF PNEUMONIA IN CHILD WITH HYPOPARATHYROIDISM
Keywords:autoimmune polyglandular type I syndrome, hypocalcaemia, acute respiratory failure, children
Background. Autoimmune diseases of parathyroid glands can lead to seizures together with respiratory
and adrenal failure. The aim of this study was to justify the importance of teamwork in making diagnosis
and treatment patient with a rare endocrine disease and to describe a case of autoimmune polyglandular syndrome I.
Case report. Female 3 years old patient was admitted to the Department of Anesthesiology and Intensive
Therapy of Lviv Regional Clinical Children Hospital «OHMATDYT» due to seizures. Level of consciousness
according to Glasgow Coma Scale was 10–11 points, there were heart rhythm disorder with prolongation of QT
interval and heart rate 63-78 per minute, respiratory rate 28–30 per minute, body temperature 37.5 °C. The abdomen was bloated and peristalsis was sluggish. SpO2
was 95 %. Patient`s body weight was 11 kg, height 79 cm,
body mass index 17.63 kg/m2. It was gained from the medical history that child did not reach normal body
weight after 1 year old. Patient`s general condition worsened 3 days before hospital admission due to general
weakness, lack of appetite, repeated vomiting after meal, decreasing water intake, diarrhea. Severe hypocalcemia and hypomagnesemia have been confirmed according to blood test result. We prescribe intravenously highdose of 10 % calcium gluconate (40.9 mg/kg/h) and 25 % magnesium sulfate (22.7 mg/kg/h) continuously. Despite
this, treatment could not stop seizures and there was progression of respiratory failure. We started invasive
mechanical ventilation via endotracheal tube and added steroids intravenously. The diagnosis was: autoimmune
polyglandular type I syndrome: hypoparathyroidism, adrenal failure; seizures; bilateral nosocomial pneumonia;
nutritional deficiency (26 % body mass deficit, body mass index 17.63 kg/m2
). The course of the disease was positive: convulsions were stopped on day 6; on day 7 patient was weaned from mechanical ventilation, and on day
33 discharged from the hospital.
Discussion. Parathyroid glands are infrequent target for autoimmune diseases. The exception is autoimmune polyglandular type I syndrome. Clinical confirmation of the hypocalcemic genesis of seizure was rhythm
disorders on the ECG with QT prolongation. We take into account the prevalence of the most common nosocomial pathogens in our hospital before the start of antibiotic therapy for severe bilateral pneumonia and fluconazole was used for prevention of fungi infection. Respiratory therapy and weaning from mechanical ventilation
were performed in accordance with the adopted hospital strategy.
Conclusion. This case is an example of successful cooperation between department of pediatric intensive
care, department of endocrinology and pediatric department, which made it possible to provide high quality
treatment, reach regression of symptoms and improve quality of life for patient
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