Additive antiproteinuric effect of enalapril plus losartan in post-hemolytic uremic syndrome (HUS) children
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Enalapril (vasotec) is an angiotensin converting enzyme (ACE) inhibitor that vaso dilates post- glomerular nephron blood vessels thereby decreasing glomerular vessel permeability, and losartan (Cozar) is a selective competitive angiotensin II receptor antagonist which not only decreases peripheral vascular resistance but also enhances impaired auto regulation of the renin system following kidney injury. Both individually decrease postdiarrheal HUS (D+HUS) proteinuria.
A post-acute study of 17 D+HUS enalapril treated proteinuric children given an additional 1.0 mg/kg/day (median dose) losartan, indicates that a further 83.8% reduction in proteinuria occurs, without significant adverse effects on serum potassium, glomerular filtration rate, and blood pressure.
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Cardio-respiratory response to moderate chloral hydrate (CH) sedation (in lambs)
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Chloral hydrate was introduced into pediatric medical use in 1894. In general it produces effective short term sedation (particularly in the less than 3 year old child) without significant adverse effects though it tends to have an unpredictable onset and long duration. It is probably superior to midazolam for procedural sedation, however it may cause mild respiratory depression, nausea and vomiting in 4-15% of children and cardiorespiratory monitoring is required.
A lung function study of 13 chronically instrumented 7-8 week old lambs which measured functional residual capacity (FRC), airway function, distal airway gas mixing, inspiratory drive and oxygenation indicates that moderate CH sedation does not affect airway function, FRC or inspiratory drive, though minute ventilation decreases slightly. Cardiovascular parameters are unaffected.
CH is a reliable sedative for lung function testing in small children.
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