Liver children

In bone, three proteins have been described which are vitamin K-dependent, osteocalcin (bone Gla protein), matrix Gla protein (MGP), and protein S. Osteocalcin is synthetized by osteoclasts, regulated by the active form of vitamin D, calcitriol. Its capacity to bind calcium needs a vitamin K-dependent y-carboxylation of three glutamic acid residues. The calcium binding capacity of osteocalcin indicates a possible role in bone mineralization, but its exact function is still unclear. However, it is widely used as a serum marker for bone mineralization. Protein S, mainly a coagulant, is also vitamin-K dependent and synthesized in the liver. Children with... 

The capacity of children to absorb, distribute, metabolize, and excrete certain substances differs from that of adults. With larger livers, children are generally more efficient in their ability to detoxify however, their developing nervous and immune systems can also make them more sensitive to the adverse effects of certain botanicals. Children are particularly vulnerable to developing significant dehydration and loss of electrolyte balance with the... 

Folic acid is a member of the vitamin B complex found in green plants, fresh fruit, yeast, and liver. Folic acid takes its name from folium, Latin for leaf. Pterin compounds are named from the Greek word for wing because these substances were first identified in insect wings. Two pterins are familiar to any child who has seen (and chased) the common yellow sulfur butterfly and its white counterpart, the cabbage butterfly. Xanthopterin and leu-... 

TABLE 19-1. Child-Pugh and MELD Classifications for Determining Severity of Liver Damage... 

Drug absorption is highly variable in neonates and infants [21,22]. Older children appear to have absorption patterns similar to adults unless chronic illness or surgical procedures alter absorption. Differences in bile excretion, bowel length, and surface area probably contribute to the reduced bioavailability of cyclosporine seen in pediatric liver transplant patients [22a]. Impaired absorption has also been observed in severely malnourished children [22b]. A rapid GI transit time may contribute to the malabsorption of carbamazepine tablets, which has been reported in a child [23]. Selection of a more readily available bioavailable dosage form, such as chewable tablets or liquids, should be promoted for pediatric patients. 

Phosphoenolpyruvate carboxykinase (PEPCK) deficiency is distinctly rare and even more devastating clinically than deficiencies of glucose-6-phosphatase or fructose-1,6-bisphosphatase. PEPCK activity is almost equally distributed between a cytosolic form and a mitochondrial form. These two forms have similar molecular weights but differ by their kinetic and immunochemical properties. The cytosolic activity is responsive to fasting and various hormonal stimuli. Hypoglycemia is severe and intractable in the absence of PEPCK [12]. A young child with cytosolic PEPCK deficiency had severe cerebral atrophy, optic atrophy and fatty infiltration of liver and kidney. 

Accidental ingestion of nickel sulfate crystals (15-20 grams) by 2.5 year-old female child Death in 4 h of heart failure blood had 7.5 mg Ni/kg, urine 50 mg/L, and liver 25 mg Ni/kg FW 6, 8... 

Criteria and Scoring for the Child-Pugh Grading of Chronic Liver Disease... 

The plasma concentration of ketone bodies in fed, healthy humans is very low (about 0.1 mmol/L) so that the rate of utilisation is very low. However, it is elevated in several conditions, e.g. starvation, hypoglycaemia, affer physical activity. In starvation in normal adults, it increases to about 3 mmol/L after three days and to 5-6 mmol/L after several more days (Figure 7.24). Nevertheless, it can increase to 3 nunol/L or higher within a few hours of completing a prolonged period of physical activity if food, particularly carbohydrate, is not eaten (known as accelerated starvation ) (Table 7.3). Ketone bodies are particularly important in children, since starvation can quickly result in severe hypoglycaemia. This is due to the fact that the amount of glycogen stored in the liver of a child is... 

Ketogenesis is particularly important even in a short period of starvation, since the requirement of glucose by the brain of a child is similar to that of an adult, yet the store of glycogen in the liver is much less. Consequently, the store would last for a much shorter time, requiring an alternative fuel for the brain. 

Generally, it appears that effects of xenobiotics on organs or endpoints may be similar in children and adults, e.g., liver necrosis observed in adults will also be observed in children. As regards toxicodynamics, age-dependent differences are primarily related to the specific and unique effects that substances may have on the development of the embryo, fetus, and child in that the physiological development of the nervous, immune, and endocrine/reproductive systems continues until adolescence (12 to 18 years). Furthermore, receptors and other molecular targets for various xenobiotics are continuously developing during the embryonic, fetal, and infant periods. This may cause age-dependent differences in the outcome of receptor-xenobiotic interactions and even result in opposite effects of xenobiotics in infants and adults. The available data are insufficient to evaluate... 

Hepatic function impairment Because iloprost elimination is reduced in patients with impaired liver function, exercise caution during iloprost therapy in patients with at least Child-Pugh class B hepatic impairment. 

Hepatic function impairment- For patients with severe liver impairment (Child Pugh class C), do not exceed a dose of 20 mg. 

Evaluate liver function tests at the start of and during the course of voriconazole therapy. Monitor patients who develop abnormal liver function tests during voriconazole therapy for the development of more severe hepatic injury. Discontinuation of voriconazole must be considered if clinical signs and symptoms consistent with liver disease develop that may be attributable to voriconazole. Hepatic function impairment It is recommended that the standard loading dose regimens be used but that the maintenance dose be halved in patients with mild to moderate hepatic cirrhosis (Child-Pugh class A and B) receiving voriconazole. 

Chronic HCV- In combination with peginterferon alfa-2a for the treatment of adults with chronic HCV infection who have compensated liver disease and have not been previously treated with interferon alpha. Patients in whom efficacy was demonstrated included patients with compensated liver disease and histological evidence of cirrhosis (Child-Pugh class A). 

The main acute effect is inebriation, which in turn spawns violence, spousal and child abuse, crime, motor vehicle accidents, workplace and home accidents, drowning, suicide, and accidental death. The chronic effects include alcoholism, liver disease, various forms of cancer, brain disorders, cardiovascular disease and other organ system effects, absence from or loss of work, family dysfunction, and malnutrition. 

A woman returns from a yearlong trip abroad with her 2-week-old infant, whom she is breastfeeding. The child soon starts to exhibit lethargy, diarrhea, vomiting, jaundice, and an enlarged liver. The pediatrician prescribed a switch from breast milk to infant formula containing sucrose as the sole carbohydrate. The baby s symptoms resolve within a few days. 

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