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To download the Chinese version of the issue digest, please click here. You may find the links to download the full version of these articles on the issue table of content page.
 
Hong Kong Medical Journal February 2004 Issue Digests
 

Obstructive sleep apnoea syndrome and obesity in children

Hong Kong Med J 2004;10:44-8

The risk of obstructive sleep apnoea syndrome (OSAS) is 4.5 times higher among children with obesity, warned researchers in their review article recently published in the Hong Kong Medical Journal. The syndrome is also associated with cardiovascular problems and psychosocial consequences.

Various studies have shown that around 13% to 36% of obese children have OSAS. The severity of the syndrome is positively related to the degree of obesity of children. The right ventricular ejection fraction is reduced in 37% of children with OSAS and 7% of children with OSAS had pulmonary hypertension. Respiratory dysfunction during sleep is also an independent risk factor of insulin-resistant syndrome.

Currently, adenotonsillectomy is the most common treatment for children with OSAS. Because children with OSAS have higher sleeping energy expenditure, the treatment is reported to increase the patient’s weight secondary to decreased energy expenditure during sleep. A study showed that, of 25 children with normal weight before adenotonsillectomy for OSAS, 7 became obese afterwards. Therefore adenotonsillectomy is recommended as a part of treatment for cases of moderate and severe OSAS only, while intensive weight reduction programme remains an important first-line definitive treatment for all obese children with OSAS, as well as those who refuse or are not fit for adenotonsillectomy.

Paediatric OSAS can result in sleep fragmentation, abnormal behaviour and learning difficulty, therefore poor school performance and emotional disturbance may occur in these children. Psychological impact of obesity may result in negative self-image as well..

 
Paracetamol poisoning after repeated supratherapeutic ingestion

Hong Kong Med J 2004;10:61-4

Inappropriate use of paracetamol can lead to toxicity and severe consequences. In the report of a paediatric case published in Hong Kong Medical Journal, doctors urged that the common “fever phobia” among parents should be corrected, and the risk of toxicity with repeated supratherapeutic intake of the easily accessible drug should not be overlooked.

A 12-month-old boy consulted 3 medical departments in 3 days, for fever, cough, diarrhoea and vomiting. He consumed a total of 2115 mg (or 232 mg/kg) paracetamol within 3 days, prescribed by different doctors. He was noticed to become less active and was admitted to Kwong Wah Hospital on the 4th day, and was subsequently transferred to the intensive care unit. On examination the boy was revealed to have a heart rate of 225 beats per minute (reference range for infants at the same age is 105-170 beats per minute), and had an episode of hypotension. He also developed shock secondary to dehydration, and had persistent diarrhoea and abdominal distention. The diagnosis was hepatatoxicity with paracetamol. His renal function remained insufficient at 10-month follow-up.

The current recommendation by the World Health Organization (WHO) for management of fever in children includes the use of paracetamol when the body temperature is 39"C or higher. The complete normalisation of a child’s temperature is indeed neither necessary nor possible. Doctors remind the public not to have a false sense of security towards commonly used drugs.
 

 

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