Mg For Children Research Articles

Underdosing of Midazolam in Emergency Endotracheal Intubation

Objectives: To determine whether midazolam, when used as an induction agent for emergency department (ED) rapid‐sequence intubation (RSI), is used in adequate and recommended induction doses (0.1 to 0.3 mg/kg), and to compare the accuracy of the dosing of midazolam for ED RSI with the accuracy of dosing of other agents. Methods: The authors conducted a systematic query of a prospectively collected database of ED intubations using the National Emergency Airway Registry data, gathered in 11 participating EDs over a 16‐month period. A data form completed at the time of emergency department intubation (EDI) enabled analysis of patients' ages, weights, and indications for EDI, as well as the techniques and drugs used to facilitate EDI. Data were analyzed to determine whether midazolam is used in recommended doses during RSI. Patients intubated with midazolam alone were compared with patients who received other induction agents for RSI. Results: Of 1,288 patients entered in the study, 1,023 (79%) underwent RSI. Of the 888 RSI patients with an age recorded, midazolam was used as the sole induction agent in 140 (16%). The mean (±SD) dosages of midazolam used in RSI were 2.6 (±1.7) mg in children (age ≤ 18) and 3.7 (±2.5) mg in adults (age ≥19); the mean (±SD) dosages by weight were 0.08 (±0.04) mg/kg in children and 0.05 (±0.03) mg/kg in adults. More than half (56%) of the children, and nearly all (92%) of the adults, received dosages lower than the minimum recommended dosage (0.1 mg/kg). Of patients who received barbiturates, only 21% of children and 21% of adults received a dose lower than the minimum recommended. When combined with another induction agent, midazolam was dosed similarly to when it was used alone: mean adult doses were 3.1 (±1.2) mg and 0.04 (±0.02) mg/kg. Conclusions: Underdosing of midazolam during ED RSI is frequent, and appears to be related to incorrect dosage selection, rather than to a deliberate intention to reduce the dose used.

Melatonin for Sleep Disorders

Developmental and Behavioral Pediatrics| August 01 2002 Melatonin for Sleep Disorders AAP Grand Rounds (2002) 8 (2): 22–23. https://doi.org/10.1542/gr.8-2-22 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Melatonin for Sleep Disorders. AAP Grand Rounds August 2002; 8 (2): 22–23. https://doi.org/10.1542/gr.8-2-22 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: melatonin, sleep disorders Source: Ross C, Davies P, Whitehouse W. Melatonin treatment for sleep disorders in children with neurodevelopmental disorders: an observational study. Develop Med Child Neurol. 2002;44:339–344. In children with neurodevelopmental disabilities (eg, epilepsy, Down syndrome, cerebral palsy, leukodystrophy, etc), the prevalence of sleep disorders may be as high as 80%.1 Forty-nine (26 male) pediatric neurology (epilepsy, n=26) outpatients from Birmingham, UK (ages 1 to 13 years) who had sleep problems (such as difficulty settling down, frequent waking, short total duration of sleep) were treated with oral melatonin at a dose titrated from 2.5 mg (5.0 mg for children over 5 years of age) to 10.0 mg (7.5 mg for children under 2 years of age). Of the 46 patients who were assessed by means of a parent-completed sleep diary, 34 showed a statistically significant (P<.05) improvement in total sleep time, night time... You do not currently have access to this content.

A Double‐Blind, Placebo‐Controlled, Dose‐Response Study of the Effectiveness and Safety of Enalapril for Children with Hypertension

Despite widespread use to treat childhood hypertension, enalapril has never been studied systematically to determine effectiveness, dose response, and safety in a pediatric population. This study was conducted prospectively in 110 hypertensive children ages 6 to 16 years in two sequential phases. The primary outcome variable for both phases of the study was trough (24-h postdose) sitting diastolic blood pressure. The primary objective of the first phase of the study was to determine whether enalapril lowered blood pressure in children in a dose-dependent manner. During a 2-week, double-blind, randomized, dose-response period, patients were stratified by weight (< 50 kg or > or = 50 kg), then assigned to one of three dosing groups: low(0.625 or 1.25 mg), middle (2.5 or 5 mg), or high dose (20 or 40 mg). Reduction in blood pressure was examined as a function of dose ratio (1:4:32) and on a weight-adjusted basis. On completion of the dose-response phase of the study, patients entered a 2-week, double-blind, randomized withdrawal to either enalapril or placebo. Antihypertensive effectiveness, defined as the difference in sitting diastolic blood pressure between the placebo and enalapril groups, was determined. Adverse events were carefully recorded throughout the study. The dose-response relationship for enalapril had a negative slope and was linear over the chosen dosing range, suggesting that larger doses of enalapril were associated with a greater reduction in blood pressure. Randomized withdrawal to active drug orplacebo confirmed the antihypertensive effectiveness of enalapril in the middle- and high-dose groups. The antihypertensive effect of enalapril was maintained across age, gender, race, and Tanner stage. Enalapril appears to be an effective and generally well-tolerated antihypertensive agent in children ages 6 to 16 years. An initial dose of 2.5 mg in children weighing < 50 kg and 5 mg in children weighing > 50 kg (mean = 0.08 mg/kg) administered once daily effectively lowered blood pressure within 2 weeks in most patients. Blood pressure was reduced in a dose-dependent fashion, with larger doses resulting in a greater reduction.

Impairment of GH responsiveness to GH-releasing hexapeptide (GHRP-6) in Prader-Willi syndrome.

The aim of this study was to evaluate the GH-releasing activity of a synthetic hexapeptide, GHRP-6, in the Prader-Willi syndrome (PWS). Sixteen PWS patients (7 males and 9 females, aged 12.7-38.3 yr), 15 with essential obesity (OB) (7 males and 8 females, aged 12.9-42.9 yr), and 8 short normal children (SN; 3 males and 5 females, aged 10.2-14.3 yr) underwent 2 tests on separate occasions, being challenged with GHRP-6 (1 microg/kg, iv) or GHRH (1 microg/kg, iv)+PD (60 or 120 mg for children or adults, po). Moreover, in 11 patients with PWS and in the group of SN, the GH response to at least 2 stimulation tests had been previously determined. GH was analyzed either as mean peak values (GHp, mcg/l), or as the area under the curve (AUC, mcg/l/h) and the net incremental area under the curve (nAUC, mcg/l/h). In the group of PWS subjects, GH responses to both GHRP-6 (GHp: 11.4+/-2.0; AUC: 588+/-113; nAUC: 483+/-108) and GHRH+PD (GHp: 7.3+/-1.8; AUC: 486+/-122; nAUC: 371+/-250) were significantly lower than those observed either in OB (GHRP-6: GHp: 25.7+/-3.2, p<0.003; AUC: 1833+/-305, p<0.005; nAUC: 1640+/-263, p<0.0001. GHRH+PD: GHp: 15.1+/-2.4, p<0.009; AUC: 1249+/-248, p<0.003; nAUC: 918+/-230, p<0.006) or in SN patients (GHRP-6: GHp: 39.1+/-3.1, p<0.0001; AUC: 2792+/-158, p<0.0001; nAUC: 2705+/-165, p<0.00005. GHRH+PD: GHp: 27.5+/-3.7, p<0.0001; AUC: 1873+/-251, p<0.0001; nAUC: 1692+/-219, p<0.0005). Unlike control groups, in PWS patients GH levels after GHRP-6 did not differ from those obtained after GHRH+PD. Interestingly, low IGF-I values were present in all PWS subjects. Furthermore, no patient with PWS showed normal GH response to the previously performed GH stimulation tests. As already reported, GH release after GHRP-6 or GHRH+PD was significantly lower in OB than in SN subjects. In conclusion, our data indicate that: 1) GH response to GHRP-6 is clearly impaired in PWS; 2) the blunted GH responses to the provocative stimuli in PWS are not an artifact of obesity; 3) short stature in PWS is caused by a complex dysfunction of the hypothalamo-pituitary structures.

Acipimox, a nicotinic acid analog, stimulates growth hormone secretion in short healthy prepubertal children.

Recent studies in adult volunteers have demonstrated that the free fatty acid reduction induced by acipimox, a nicotinic acid analog, stimulated GH secretion per se and enhanced in an additive manner the GH secretion elicited by such different stimuli as pyridostigmine, GHRH and GHRP-6. In order to evaluate whether acipimox administration stimulates GH secretion in prepubertal children, we administered a single oral dose of acipimox (100 mg for children weighing <30 kg and 200 mg for those >30 kg) to 14 healthy prepubertal children with a mean age of 8.2 +/- 1.9 years, a mean bone age of 6.2 +/- 3.0 years, growing along the 5-10th percentiles, and with normal thyroid function and IGF-I levels. Acipimox administration elicited a sustained increase in GH from a mean baseline level of 0.6 +/- 0.4 to 6.7 +/- 2.4 microg/l at the end of the test (p<0.05), with a mean GH peak of 10.5 +/- 3.5 microg/l. GH release was delayed so that peak GH levels were achieved 180 minutes after acipimox administration. In order to determine whether acipimox was capable of enhancing the GH secretion elicited by levodopa (L-Dopa), we administered either oral L-Dopa (250 mg for children weighing <30 kg and 500 mg for those >30 kg) or oral acipimox plus L-Dopa to the same children on different days. GH concentrations increased in a similar fashion following either of these tests (from a baseline level of 1.2 +/- 0.4 and 0.7 +/- 0.4 microg/l to 8.4 +/- 2.7 and 9.3 +/- 2.9 microg/l at the end of the test (p<0.001), with peak GH concentrations of 13.1 +/- 4.1 and 11.8 +/- 3.3 microg/l after L-Dopa or acipimox plus L-Dopa, respectively). Although the peak GH concentrations obtained after the combined administration of acipimox plus L-Dopa were similar to those obtained after either acipimox or L-Dopa administration, a larger number of our patients reached a GH cut-off point of >7 microg/l following combined therapy than with either stimulus alone (13/14 patients with combined therapy and 10/14 with acipimox alone). No side effects other than mild facial flushing were noted after acipimox administration. These results indicate that: 1) following the administration of a single oral dose of acipimox, significant GH secretion was elicited in healthy short prepubertal children; 2) the combined administration of acipimox plus L-Dopa did not, however, enhance the GH secretion of this group of children; 3) acipimox was well tolerated with minimal side effects; and 4) further studies in both GH sufficient and GH deficient children are necessary to evaluate acipimox's usefulness in assessing GH reserve.

High lead exposures resulting from pottery production in a village in Michoacán State, Mexico.

This paper reports findings from a screening study conducted to examine potential lead (Pb) exposures in residents of a Mexican village where Pb oxide continues to be used in ceramic pottery production. Extremely high Pb concentrations were measured in personal and indoor air samples, household surface dust samples, and household soil samples. Personal air Pb concentrations for workers performing pottery firing and glazing were up to 454 microg/m3. Results from indoor air samples indicate that airborne Pb concentrations were lower during nonglazing period compared to the glazing period. Soil Pb concentrations measured in 17 homes ranged from 0.39 to 19.8 mg/g. Dust Pb loading on surfaces of household items, hands, and clothes of a worker ranged from 172 to 33,060 microg/ft2. Pb content as high as 2.4 microg/g was found in a bean stew cooked in a pot made in the village. Based on these Pb concentrations measured in multiple media and data adapted for exposure contact rates, we have made rough estimates of Pb exposures via inhalation, soil/dust ingestion, and food ingestion. Estimated total daily Pb intake, on average, is 4.0 mg for adults and 3.4 mg for children living in the village. In the total daily intake, a greatest fraction may be contributed by food ingestion and another significant fraction may come from soil/dust ingestion for the children. Although the sample size is small, these measurements indicate a very significant public health problem for the village residents and a large number of other similar communities in Mexico. (It was estimated that there are approximately 1.5 million glaze potters.) The Pb exposure is implicated in a number of pervasive health problems in the region, and is the cause for national and international attention. Several recommended solutions to this problem range from personal protection and behavioral changes to introduction of alternative glazes.

Absence of Cardiovascular Adverse Effects of Sertraline in Children and Adolescents

In a 12 week, placebo-controlled, parallel-design, multicenter study of sertraline for obsessive-compulsive disorder in 107 children and 80 adolescents, the authors prospectively assessed cardiovascular effects to doses of sertraline of < or = 200 mg/day. Vital signs (blood pressure and heart rate) and electrocardiograph parameters (ECGs) were systematically evaluated at baseline and again throughout treatment. There were no clinically significant cardiovascular adverse events in any of the subjects enrolled in the study. Moreover, compared with baseline and placebo, sertraline treatment at an average dose of 167 mg did not result in any clinically meaningful changes in any ECG indices (PR, QRS, and QTc intervals), cardiac rhythm, blood pressure, or heart rate. These prospectively derived results support the cardiovascular safety of sertraline at doses up to 200 mg in children and adolescents.

Brick tea consumption as the cause of dental fluorosis among children from Mongol, Kazak and Yugu populations in China

Dietary fluoride intake and the prevalence of dental fluorosis were investigated in children from three population groups (Mongol, Kazak and Yugu) in Gansu Province, China. The concentration of fluoride in drinking water ranged from 0.11 to 0.32 mg/litre; there was no other fluoride pollution. There was a high prevalence of dental fluorosis—52, 84 and 76% among the Mongol, Kazak and Yugu children, respectively). Dental fluorosis was particularly severe among the Kazak population (severity index: 2.00, 3.05 and 2.57 among the three populations, respectively). Each of the population groups had a long tradition of drinking milk tea made from brick tea water. This milk tea was found to contain high concentrations of fluoride (2.58–3.69 mg/litre). The daily fluorine consumption was 1.36–2.42-times the US RDA of 2.5 mg for children. Regression analysis showed that fluorosis was significantly correlated with the consumption of milk tea made from brick tea water, but not with any other dietary component (including milk).

Intravenous Ondansetron in Established Postoperative Emesis in Children

In pediatric postsurgical patients, postoperative vomiting is a common occurrence that can delay recovery and result in unplanned hospital admissions after outpatient surgery. This randomized, double-blind, placebo-controlled, multicenter study evaluated the efficacy and safety of ondansetron in the control of established postoperative emesis in outpatients aged 2-12 yr. Screened for the study were 2,720 ASA physical status 1-3 children undergoing outpatient surgery during general anesthesia, which included nitrous oxide. Children experiencing two emetic episodes within 2 h of discontinuation of nitrous oxide were given intravenous ondansetron (n = 192; 0.1 mg/kg for children weighing < or = 40 kg; 4 mg for children weighing > 40 kg) or placebo (n = 183). The proportion of children with no emetic episodes and no use of rescue medication was significantly greater (P < 0.001) in the ondansetron group compared with placebo for both 2- and 24-h periods after study drug administration (78% of the ondansetron group and 34% of the placebo group for 2 h; 53% of the ondansetron group and 17% of the placebo group for 24 h). Among patients with at least one emetic episode or with rescue medication use, the median time to onset of emesis or rescue was 127 min in the ondansetron group compared with 58 min in the placebo group (P < 0.001). The median time from study drug administration until discharge was significantly shorter (P < 0.01) in the ondansetron group (153 min, range 44-593 min) compared with the placebo group (173 min, range 82-622 min). The incidence of potentially drug-related adverse events was similar in the ondansetron (3% of patients) and the placebo (4% of patients) groups. A single dose of ondansetron (0.1 mg/kg up to 4 mg) is effective and well tolerated in the prevention of further episodes of postoperative emesis in children after outpatient surgery. Administration of ondansetron also may result in a shorter time to discharge.

A comparison of amitriptyline, vasopressin and amitriptyline with vasopressin in nocturnal enuresis

Forty-five children aged 6-14 years with primary nocturnal enuresis were randomised to determine whether desmopressin is more effective than amitriptyline and whether the combination of amitriptyline/desmopressin is more effective than amitriptyline or desmopressin alone. Amitriptyline dosage was 25 mg for children 6-10 years and 50 mg for children aged 10-14 years. Desmopressin (20 micrograms) was given in the same dosage for all age groups. After a run-in period of 2 weeks, children were treated for 16 weeks and then observed for 12 weeks. In the amitriptyline group mean wet nights per week decreased from 5.8 +/- 0.9 to 3.3 +/- 1.9 (P < 0.0005); in the desmopressin group mean wet nights per week decreased from 6.0 +/- 0.9 to 4.7 +/- 1.7 (P < 0.02); in the amitriptyline/desmopressin group mean wet nights per week decreased from 6.3 +/- 0.9 to 3.3 +/- 2.5 (P < 0.0006). When comparing the groups, amitriptyline/desmopressin and amitriptyline were statistically more effective than desmopressin in week 6 (P < 0.009), week 8 (P < 0.03) and week 10 (P < 0.04). No significant side effects occurred. At this dose amitriptyline was more effective than desmopressin and the combination of desmopressin and amitriptyline did not confer any additional benefit.

High doses of furosemide in children with acute renal failure

The diuretic effect of high doses of furosemide alone and furosemide plus mannitol was analysed retrospectively in 30 children with acute renal failure. In 10 children (Group 1) renal failure developed mainly during glomerulonephritis, and in 20 children (Group 2) the cause was gastroenteritis. The diuretic effects of furosemide and furosemide plus mannitol were evaluated measuring the 24-hour urine volume at the time of anuria, oliguria or normal diuresis. The highest mean single intravenous doses of furosemide were 6.5 and 14 mg/kg in Groups 1 and 2, respectively; the highest average daily doses were 10.1 and 25.5 mg/kg, respectively. A broad relationship was observed between single i.v. dose and diuretic response following administration of furosemide (1.2 to 30.8 mg/kg). In both groups of patients a statistically significant negative linear correlation was found between the daily intravenous dose of furosemide and the 24-hour urine volume. Calculations based on the obtained regression equations showed that the expected 24-hour urine volumes corresponding to daily diuresis normal for age could be obtained after administration of daily 2.8 to 1.4 mg/kg furosemide in Group 1 and 9.3 to 2.3 in Group 2. It is therefore suggested that the total daily dose of furosemide should not exceed 100 mg in children with acute renal failure. Administration of furosemide plus mannitol did not result in higher daily diuresis as compared to 24-hour urine volume obtained when furosemide was given alone. Furosemide was well tolerated. Electrolyte disturbances, especially in Group 2, were the most frequent side effects due to high doses of furosemide.

Nitrate, nitrite, and N-nitroso compounds in Finnish foods and the estimation of the dietary intakes

An estimate of the dietary intakes of nitrite, nitrate and N-nitroso compounds is presented, based on the analytical data supplied by the Finnish Food Quality Control. Figures on the food consumption of the Finnish population, taken from a national dietary survey, and food consumption of 1768 children and adolescents over a 48-h recall period were used. The mean daily dietary nitrate intakes were estimated to be about 55 mg for the total population and for children and adolescents. The mean nitrite intakes were 1.88 mg for the total population and 1.07 mg for children and adolescents. The intake of N-nitroso compounds (NDMA) was estimated to be 0.08 micrograms for the total population and 0.02 micrograms for children. Nitrates were found to originate mainly from vegetables (80%), nitrites from meat products (97%) and nitrosamines mostly from fish products and beer. A comparison of the estimate of dietary intake of with ADI values indicated that the nitrite intake of the total population was 23% and by children 39% of ADI. The average weight was approximately 60 kg for adults and 20 kg for children. When measured average weight (39 kg) was used, and the nitrite intake was found to be 28% of ADI. Nitrate intakes from food additives were 2.5% and 1.4% of the ADI value, respectively. When the total nitrate intake from various food sources was compared with the ADI (which is given only for food additives), the estimated nitrate intake of the total population was 25% and that of children 28% of the ADI value.

Effect of the potentiation of cholinergic activity on the variability in individual GH response to GH-releasing hormone

In man the GH response to GHRH is highly variable and some normal subjects may be completely unresponsive to the neuropeptide. On the other hand, the potentiation of cholinergic activity by pyridostigmine (PD), a cholinesterase inhibitor, increases the GH response to GHRH, probably by inhibiting somatostatin release. The aim of this study was to assess the existence of intraindividual variability in the GH response to GHRH and verify the effects of PD treatment on inter- and intraindividual variability. Twenty normal adults (17 M and 3 F) and 10 normal prepubertal children (9 M and 1 F) underwent 2-5 administrations of 1 micrograms/kg GHRH on different days. Seven adults and all children also underwent 1-5 other tests in which GHRH was preceded (60 min before) by oral PD (120 mg in adults and 60 mg in children). The GH responses to GHRH were highly variable, not only within subjects but also in the same subject on different occasions (peak range; adults: 0.4-49.0 ng/ml; children: 2.4-50.0 ng/ml). PD always markedly increased the GH response to GHRH, even unmasking this response in 3 adults and 4 children hyporesponsive to the neuropeptide alone. However, the variability in the GH response was still present (adults: 27.2-108.5 ng/ml; children: 25.0-144.0 ng/ml), though reduced (adults: p = 0.0005; children: p = 0.0204). These data indicate that: i. A great inter- and intraindividual variability in the GH response to GHRH is present.(ABSTRACT TRUNCATED AT 250 WORDS)

Dosage of nifedipine in hypertensive crises of infants and children.

Eight hypertensive crises (HC) were treated with 2.5 mg of sublingual nifedipine in three children with weights below 10 kg (group A); 16 HC in 6 children between 10 and 20 kg with 5 mg (group B); and 40 HC in 10 children over 20 kg with 10 mg of nifedipine (group C). The relative decrease in both systolic and diastolic blood pressure was similar in all groups. The decrease was more rapid in groups A and B when the contents were extracted from the capsule and given directly. The hypotensive effect lasted 4 h. There were no side effects. The effective and safe single dose of nifedipine has been established to be 2.5 mg for children weighing less than 10 kg, and 5 mg for children weighing between 10 and 20 kg.

Treatment of hypertensive crisis in children with nifedipine.

We report 31 episodes of hypertensive crises in children, managed with sublingual nifedipine at the following dosages: 10 mg in children with body weight (BW) higher than 20 kg, 5 mg in children with BW between 10 and 20 kg, and 2.5 mg in children with BW below 10 kg. The mean initial blood pressures were 161.41 mm Hg for the systolic pressure (mSBP) and 111.25 mm Hg for the diastolic pressure (mDBP). After nifedipine, both the mSBP and the mDBP decreased, with onset of effect five minutes after dosage and maximum decrease at 60 min (mSBP 134.93 mm Hg, mDBP 79.23 mm Hg, for decreases of 16.4 and 28.7%, respectively), and this effect persisted for 180 min. Blood pressure increased again from min 240 to min 360, yet without reaching the initial levels. One case did not respond to the first dose of nifedipine and required a second one. The effect of nifedipine was more pronounced on the DBP than on the SBP, and greater reductions of both pressures were achieved in the cases with higher initial readings. No side of medication were observed in our patients.

EFFECT OF A SINGLE ORAL DOSE OF PREDNISOLONE IN ACUTE CHILDHOOD ASTHMA

140 children of 184 with acute asthma entered a randomised double-blind trial of oral prednisolone (n = 67) compared with placebo (n = 73) administered soon after admission. The dose of prednisolone was 30 mg in children under 5, otherwise 60 mg. All children also received salbutamol. All had moderate or severe dyspnoea. Initial evaluation was similar for both groups. On reassessment after a few hours 20 children in the prednisolone group were fit for discharge compared with only 2 in the placebo group. There were no early reattendances. Children remaining in hospital had a shorter median duration of stay and were less likely to require further steroid therapy if they had initially received prednisolone. In acute asthma the prompt use of a single dose of oral prednisolone can reduce morbidity and the need for hospital care.

Prazosin for vasodilator treatment of acute pulmonary oedema due to scorpion sting.

Prazosin hydrochloride, a post-synaptic alpha receptor blocking agent, was administered to twelve patients with acute pulmonary oedema due to scorpion sting in order to lower their mean blood pressure (diastolic blood pressure plus one-third of pulse pressure) 10 to 20 mmHg. Following an oral dose (0.125 mg in children and 0.5 mg in adults), clinical improvement was seen in the form of disappearance of apical systolic murmur and pulmonary oedema, a reduction in heart rate observed at the end of the first hour, and maximal improvement seen at the end of the third hour. Chest radiographs showed conspicuous clearing of pulmonary oedema. Electrocardiographs (ECG) showed hypoxic injury patterns such as a Q-wave in lead I and AVL with tented T waves in precordial leads, left anterior hemiblock (LAHB) and acute infarction patterns with subsequent T-wave inversion. The severity of clinical signs and ECG changes increased as the time between the sting and attending hospital lengthened.

Hazards of Prolonged Use of Beclomethasone Spray

To the Editor.— In a recent issue ofThe Journal(1982;247:885), a question was raised and a reply given by Irwin J. Polk, MD, regarding use of beclomethasone dipropionate spray. The reply is, in my opinion, likely to be misleading to physicians and to result in denying valuable treatment to many patients for whom the quality of life could be greatly improved with little risk of serious side effects. Internists and pediatricians in the United Kingdom and elsewhere have now had up to ten years experience with this inhaled steroid in patients of all ages with asthma. In therapeutic doses of up to 800 mg in adolescents and adults and up to 400 mg in children, it has proved to be largely free of serious side effects. Clinical experience does not suggest significant suppression of the hypothalamic-pituitary-adrenal axis, even after many years of continuous use. Planned studies in children such

小児のへん桃摘出術後炎症，とう痛に対するボルタレン座剤の効果ならびに血中濃度の推移の検討

The efficacy and tolerability of diclofenac sodium suppositories administered 25mg b. i. d. for 5 days to children with post-tonsillectomy pain and inflammation were investigated in a well-controlled study of 40 patients comparing it with the treatment with a non-diclofenac sodium drug. In this trial, diclofenac sodium showed quick onset of analgestic action and was superior to the treatment with a non-diclofenac sodium drug in the analgestic and anti-inflammatory effect after 3 days. There was no difference in efficacy between 2 treatments after 5 days.Laboratory tests (hematology, serum biochemistry and urinalysis) were normal, and mild vomiting was reported for diclofenac sodium. Plasma concentrations of diclofenac were measured following a single dose of diclofenac sodium 25mg in 5 children.No difference was observed in the peak plasma concentrations (C Max) or time to reach the peak concentration (t Max) between diclofenac sodium 25mg in children and diclofenac sodium 50mg in adults.

Levels of optimal vitamin C intake in individuals as estimated by the lingual tests.

The optimal levels of vitamin C intake in human individuals have been disputed ever since the isolation of the vitamin (1). On the one hand, the Food and Nutrition Board has set the recommended daily dietary allowances for vitamin C at 40 mg for children, 45-60 mg for adolescents, and 55-60 mg for adults. On the other hand, there are strong suggestions that the optimal levels of intake for the well-being of human individuals may be far above the recommended daily dietary allowances (1-3). Certainly optimal levels could also vary greatly from individual to individual (3, 4). It seems that a simple and rapid method for estimating how much vitamin C an individual needs would be highly desirable. Methods. This report presents results of an attempt to apply the lingual ascorbic acid test reported by Giza and Weclawowicz (5), and also studied extensively by Cheraskin and Ringsdorf (6-8). Volunteers, 47 in number, were recruited from staff members and students at the University of Texas. They were asked to follow their usual dietary habits except to avoid any ascorbic acid supplementation for 3 days prior to the tests. The tests were done in the early mornings under overnight fasting conditions. The technique was as described by Cheraskin and Ringsdorf with the modification of applying the 2,6-dichlorophenolindo-phenol reagent with a micropipette to obtain accurate drops of 0.01 ml in volume. The initial decolorization times of the 47 volunteers ranged from 8-65 sec. In three other volunteers, not included in the study, the droplet of reagent remained as such on the tongue and would not spread. Volunteers showing a long decolorization time (longer than 10 sec) were given ascorbic acid supplementations at graded levels: 500, 1,000, and 2,000; 3,000 and 4,000 mg if necessary, to decrease the decolorization time.