Clinical manifestations of valproic acid (VPA) toxicity can range from just mild confusion and drowsiness to serious encephalopathy, leading to depressed sensorium and even coma and death. The exact cause(s) of how VPA influences the integrity of brain function remains unknown. Nevertheless, several mechanisms have been postulated including a surge in the blood ammonia concentration. Valproic acid–induced hyperammonemic encephalopathy is a rare yet serious sequalae and that can lead to grave outcomes. We report a case of hyperammonemic encephalopathy with preserved liver function following a moderate VPA intoxication in a toddler, who was successfully managed conservatively. Additionally, we briefly discuss mechanistic basis of VPA toxicity and highlight some of the available potential therapies.

Background A retropharyngeal abscess (RPA) is a deep neck infection that considers a medical emergency because of the possibility of serious complications including life-threatening upper airway obstruction, mediastinitis, and sepsis. Materials and Methods We present our experience in Benghazi Children's Hospital, describing the clinical presentations, diagnostic workup, management, and the outcome of four children presented during the time period between November 2017 and November 2021 as cases of RPA secondary to penetrating trauma to the posterior pharyngeal wall either due to ingestion of a foreign body or due to manipulation of tonsils by the traditional therapist. Results All cases presented with fever, poor feeding, and hyperextension of the neck. All were diagnosed by ultrasound and they needed surgical drainage of RPA, as they did not improve with medical treatment alone. Conclusion A high index of suspicion is necessary for the early diagnosis and treatment of RPA. Two of our cases were presented following the manipulation of tonsils by a traditional therapist, so we attempted to emphasize this life-threatening consequence after traditional therapy, as well as the unnecessary morbidity and mortality associated with this ongoing traditional treatment in our country.

Sickle cell Anemia (SCA) is a common inherited haemoglobinopathy resulting from a single-point mutation on the β-globin subunit of hemoglobin. It is a chronic condition with multi-system involvement. Growth delay, osteopenia and hypogonadism are common endocrine dysfunctions with a lower frequency of impaired glucose tolerance. However, there is an association between SCA and diabetes mellitus (DM), though it is very rare. Certainly, there are only a few published reports worldwide outlined this uncommon combination. In this report, we will present the first Libyan case study of co-existence of the two diseases in a-16-month-old male toddler recording the youngest patient diagnosed with such a rare combination. The child, who was diagnosed earlier with SCA, brought with concerns of frequent changing nappies (polyuria) and excessive thirst (polydipsia) for 2 weeks that worsened recently. On admission, the toddler was distressed, lethargic and his lab parameters showed hyperglycemia, ketonuria, glycosuria and acidosis, a diagnosis of diabetic ketoacidosis (DKA) on the background of SCA therefore was made. Further observations are warranted to properly guide about the diagnosis and management of such rare cases.

Objective of study: To review the etiology, clinical profile, and outcome of status epileptics (SE) in pediatric age group. Methods: Data from 50 cases was obtained prospectively which admitted to intensive care unit Benghazi children hospital from between May, 2019 and May, 2020 Patients aged between 30 days and 15 years with the symptoms of SE were selected for this study exclusion criteria convulsion at neonatal age and patient with non-convulsive status epileptics. Results: The data show that Male sex of the cases was predominant as they represented 58% complemented by 42% females: Although male gender was greater than female among the cases, the deaths were 50% male and 50% female, so mortality was equal etiology of the status epileptics it was observed that, in 62% of the sample due to acute symptomatic condition, in 26% due to remote symptomatic illness, unclassified reason was reported in 6%, complex febrile convulsion in 4% and epilepsy related in 2%. Type of seizure was generalized tonic-clonic convulsion in 94% and focal in 6%. Of cases Number of drug used for the cases was one drug in 2%, two drugs in 20%, three drugs in 60% and four drugs in 18%. More than have of the cases (52%) were classified as refractory to anticonvulsant therapy, 8% were super-refractory. 40% of the sample responded to two anticonvulsant medications Outcome of death happened in 20% of the cases (10 cases) and transfer to the ward was done for 80%. Conclusion: Patients with younger age and male sex are slightly more vulnerable to develop SE. Longer duration of SE and acute symptomatic an etiology are independent predictors for poor outcome status epileptics.

Hemophagocytic lymphohistiocytosis (HLH) is a lethal and rapidly progressive hyper-inflammatory state that lead to development of fulminant multi-organ failure. HLH is divided into primary or familial HLH (FHL) and secondary HLH (sHLH). It can be triggered by a variety of agent that affect the immune system, infection is a common triggering agent. Recently, Coronavirus disease (COVID-19) has spread all over the world and was declared a pandemic. COVID-19 infection in children can induce serious hyper-inflammatory syndrome termed multisystem inflammatory syndrome (MIS-C). Clinically MIS-C patients present with features that resemble Kawasaki’s disease or toxic shock syndrome and the clinical and laboratory manifestations may also similar to that of secondary hemophagocytic lymphohistiocytosis, or macrophage activation syndrome (MAS). The reported HLH syndrome in children with COVID-19 increased during 2020-2021. In this case series we present two pediatric patient diagnosed as sHLH post- COVID-19 infection with a brief literature review of similar pediatric patients.