We hypothesized that—as in other common pediatric conditions—acute appendicitis (AA) could be complicated by acute kidney injury (AKI). We aimed to investigate the prevalence of, and the factors associated with AKI in a cohort of patients with AA. We retrospectively collected data of 122 children (63.9% of male gender; mean age 8.6 ± 2.9 years; range: 2.2–13.9 years) hospitalized for AA. AKI was defined according to the Kidney Disease/Improving Global Outcomes creatinine criteria. We considered a basal serum creatinine value as the value of creatinine estimated with the Hoste (age) equation, assuming that the basal estimated glomerular filtration rate (eGFR) was 120 mL/min/1.73 m2. Explorative univariate logistic regression analysis was used to explore the associations with AKI. Out of 122 patients, nine (7.4%) presented with AKI. One patient had stage two AKI and the remaining had stage one AKI. The maximum AKI stage was found at admission. The patients with AKI showed a higher prevalence of fever ≥ 38.5 °C (p = 0.02), vomiting (p = 0.03), ≥5% dehydration (p = 0.03), and higher levels of both C-reactive protein (CRP) (p = 0.002) and neutrophils (p = 0.03) compared with patients without AKI. Because all patients with AKI also presented with vomiting, an Odds Ratio (OR) for the vomiting was not calculable. The exploratory univariate logistic regression analysis confirmed that fever ≥ 38.5 °C (OR = 5.0; 95% CI: 1.2/21.5; p = 0.03), ≥5% dehydration (OR = 8.4; 95% CI: 1.1/69.6; p = 0.04), CRP (OR = 1.1; 95% CI: 1.05/1.2; p = 0.01), and neutrophil levels (OR = 1.1; 95% CI: 1.01/1.3; p = 0.04) were all predictive factors of AKI. AKI can occur in 7.4% of patients with AA. Particular attention should be paid to the kidney health of patients with AA especially in the presence of vomiting, ≥5% dehydration, fever ≥ 38.5 °C, and high CRP and neutrophils levels.

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An 8-year-old girl arrived in the Emergency Department presenting with sudden unilateral right trismus, deviation of the jaw, burning pain in the neck with dystonic deviation of the same backwards and dyskinesia. The mother reported that the child started vomiting and that three days before she had started therapy with metoclopramide 0.5 mg/kg/day IM following her paediatrician’s indication. In the suspicion of metoclopramide-induced extrapyramidal symptoms, blood chemistry tests were performed showing normal results and midazolam 0.2 mg/kg was administered leading to regression of symptoms. After twenty minutes symptoms recurred with pain-induced sinus tachycardia (HR 180 BPM). Therefore, she was administered a second dose of midazolam EV at 0.15 mg/kg that led to a complete and definitive regression of symptoms. Metoclopramide is a neuroleptic drug indicated only for the treatment of post-operative vomiting or chemotherapy in children over one year. The most common adverse reaction is the onset of extrapyramidal symptoms. A careful risk-benefit balance must always be performed before deciding whether to administer an antiemetic drug.