Today, Dr. Monica Gray, Dr. Pradip Kamat, and Dr. Rahul Damania discuss two real-life pediatric cases of hyponatremia in the PICU. They talk through a case of a six-month-old baby with severe sodium depletion and a teenager dealing with cancer-related hyponatremia. The team breaks down the pathophysiology, walks us through the diagnostic workups, and discusses the careful management needed for these cases. They emphasize the importance of correcting sodium levels gradually and addressing the root cause of the problem. They share practical tips for intensivists and highlight why staying vigilant and following evidence-based care is so crucial when managing critically ill kids with electrolyte disturbances. Tune in to hear more!

Show Highlights:

• Discussion of hyponatremia in pediatric patients, particularly in the PICU
• Presentation of two case studies illustrating different presentations of hyponatremia
• Examination of the pathophysiology of hyponatremia, including its classification into hypovolemic, euvolemic, and hypervolemic types
• Overview of diagnostic investigations for hyponatremia, including volume status assessment and serum/urine electrolyte measurements
• Management strategies for hyponatremia, emphasizing the importance of gradual correction of sodium levels
• Risks associated with rapid correction of hyponatremia
• Importance of fluid management in different types of hyponatremia
• Role of pharmacological interventions in specific cases, such as SIADH
• Clinical presentation and symptoms associated with hyponatremia in pediatric patients
• Emphasis on continuous monitoring of sodium levels and clinical status during treatment

References:

• Fuhrman & Zimmerman - Textbook of Pediatric Critical Care Chapter 71. Fluid and electrolyte issues in pediatric critical illness. Evans I, Joyce E. Page 866-872
• Rogers' textbook of Pediatric Intensive Care Chapter 108: Disorders of Water, Sodium and Potassium homeostasis: Schneider J & Glater-Welt L. Pages 1868-1880
• Harrison’s Principles of Internal Medicine Volume 1. Chapter 53: Fluid and Electrolyte Disturbances. Mount D. Pages 338-347

Today, Dr. Rahul Damania, Dr. Pradip Kamat, and Dr. Monica Gray, pediatric intensivists, sit down to chat about the diagnosis and management of acute myocarditis in children. They focus on a real-life case involving a one-month-old infant who presented with poor feeding, respiratory distress, and fever. Together, they break down the possible causes, key clinical signs, diagnostic approaches, and treatment options for pediatric myocarditis. Throughout the discussion, they highlight the importance of early recognition, a multidisciplinary team approach, and supportive care in improving outcomes for these critically ill infants. This episode is packed with practical insights and is designed to help pediatric intensivists tackle this challenging and potentially life-threatening condition. Tune in to hear more!

Show Highlights:

• Definition and etiology of acute myocarditis in pediatric patients
• Clinical case presentation of a one-month-old infant with acute myocarditis
• Symptoms and clinical manifestations of acute myocarditis in children
• Diagnostic approaches for identifying acute myocarditis, including echocardiography and laboratory tests
• Management strategies for acute myocarditis, including intensive care and medication
• Importance of recognizing atypical presentations in infants
• Prognosis and risk factors associated with acute myocarditis
• Role of multidisciplinary collaboration in managing acute myocarditis
• Impact of viral infections on the development and severity of myocarditis
• Outcomes and potential complications related to acute myocarditis in pediatric patients

References:

• Fuhrman & Zimmerman - Textbook of Pediatric Critical Care Chapter 108. Life-threatening viral diseases and their treatment. Vora S et al. Pages 1273-1278
• Rogers’ textbook of Pediatric Intensive Care. Chapter 74: cardiomyopathy, myocarditis, and mechanical circulatory support. Harmon WG et al. Pages 1247-1255
• Robinson J, Hartling L, Vandermeer B, Sebastianski M, Klassen TP. Intravenous immunoglobulin for presumed viral myocarditis in children and adults. Cochrane Database Syst Rev. 2020 Aug 19;8(8): CD004370. Doi: 10.1002/14651858.CD004370.pub4. PMID: 32835416

In this episode of "PICU Doc on Call," pediatric intensivists Dr. Rahul Damania, Dr. Pradip Kamat, and Dr. Monica Gray discuss a critical case involving a 16-year-old male who experienced severe carbon monoxide poisoning after being found unresponsive in a garage. They chat about the pathophysiology, clinical manifestations, diagnostic workup, and management of carbon monoxide toxicity. Furthermore, they cover the importance of early oxygen administration, recognizing potential delayed neurological sequelae, and keeping an eye out for cardiac complications. Tune in and hear more about a comprehensive approach to treatment and the significance of multidisciplinary support for achieving the best patient outcomes.

Show Highlights:

• Case presentation of a 16-year-old male with severe carbon monoxide poisoning
• Pathophysiology of carbon monoxide toxicity and its effects on hemoglobin
• Clinical manifestations and symptoms associated with carbon monoxide poisoning
• Diagnostic workup for suspected carbon monoxide exposure
• Management principles for treating carbon monoxide poisoning in pediatric patients
• Sources and scenarios leading to carbon monoxide poisoning
• Complications arising from carbon monoxide exposure including neurological injuries
• Importance of early oxygen administration and monitoring in treatment
• Discussion of hyperbaric oxygen therapy and its indications
• Key takeaways for clinicians regarding the management and follow-up of carbon monoxide poisoning cases

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References:

• Tapking, C., et al. (2021). Burn and inhalation injury. In J. J. Zimmerman & A. T. Rotta (Eds.), Fuhrman and Zimmerman’s Pediatric Critical Care (6th ed., pp. 1347–1362). Elsevier.
• Nañagas KA, Penfound SJ, Kao LW. Carbon Monoxide Toxicity. Emerg Med Clin North Am. 2022 May;40(2):283-312. doi: 10.1016/j.emc.2022.01.005. Epub 2022 Apr 5. PMID: 35461624.
• Smollin C, Olson K. Carbon monoxide poisoning (acute). BMJ Clin Evid. 2010 Oct 12;2010:2103. PMID: 21418677; PMCID: PMC3217756.
• Palmeri R, Gupta V. Carboxyhemoglobin Toxicity. [Updated 2023 Apr 17]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan.