Evaluation of QTc Interval Effects of Antipsychotic Medications for Intensive Care Unit Delirium in Pediatric Patients

Hutchins, Lisa M.; Shipman, Andrakeia; Zimmerman, Kanecia O.; Heath, Travis

doi:10.5863/1551-6776-26.1.87

Cited by 4 publications

(2 citation statements)

References 25 publications

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“…It was found that patients with hypomagnesaemia had significantly longer PICU duration. A finding similar to the extension of ICU stay in patients with hypomagnesaemia was also found in Deshmukh et al, Chen et al, And Kumar et al study 22 . A relationship between hypomagnesaemia and other electrolyte disturbances was found in one third of the cases in this study.…”

Section: Discussionsupporting

confidence: 85%

Outcome and Incidence of Hypomagnesemia in Children Admitted in Pediatric Intensive Care Unit of a Tertiary Care Hospital

Farrukh¹,

Masood²,

Shakoor³

et al. 2021

PJMHS

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Background: Magnesium deficiency is common in serious diseases and is often associated with mechanical ventilation, mortality, and long-term intensive care. Awareness of hypomagnesaemia is essential because little data is available and may have prognostic and therapeutic implications. Aim: This study was conducted to calculate the incidence of hypomagnesaemia at PICU admission and to relate it to length of PICU stay, duration of mechanical ventilation, and outcome of hospital stay or discharge. Place and Duration: In the Pediatric Intensive Care Unit (PICU), Abbasi Shaheed Hospital, Karachi for one-year duration from April 2020 to April 2021. Methods: This is a prospective observational study involving 200 children aged 1 month to 12 years admitted to the PICU. All qualified children underwent an interview and clinical examination. Blood was collected during admission to calculate serum magnesium level. The patients were grouped into three groups: normomagnesemia, hypomagnesaemia and hypermagnesemia, and the data were analyzed. Results: 200 children were included in the inclusion study. Males constituted 57.0%and females 43.0%. The ratio of men to women was 1.2: 1. Most of the respondents were 5 years old. Most of the respondents were in the ICU with neurological symptoms (36.5%), followed by respiratory diseases (27%). Of the 200 patients, 138 (69%) had a mean magnesium level of 1.9 mg / dL. 51(25.5%) patients had hypomagnesaemia. The average magnesium level was 1.3 mg / dL. 11 (5.5%) patients had hypermagnesemia with a mean magnesium content of 2.7 mg / dl. The lowest measured magnesium level was 1 mg / dl and the highest was 4.2 mg / dl. There was no statistically significant association between hypomagnesaemia and gender, age, disease acceptance category, and sepsis. ≤ 27.4% of children under 5 years of age had severe acute malnutrition in the hypomagnesaemia group. Among those with normal magnesium levels, 24% had severe acute malnutrition and 27.3% had severe acute malnutrition among those with hypermagnesemia. In the study, overall mortality was 25% (50 out of 200). Mortality among people with hypomagnesaemia was 29.40%. Among those with normal magnesium levels, 21.2% died and 18.2% in the hypermagnesemia group. Conclusion: Patients with hypomagnesaemia have prolonged PICU stay, other related electrolyte disturbances and increased mortality. Therefore, in severe ill patients, magnesium levels are monitored. Keywords: Children, Hypomagnesaemia, Intensive Care Unit, Mortality, Outcome, ICU

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Section: Discussionsupporting

confidence: 85%

Outcome and Incidence of Hypomagnesemia in Children Admitted in Pediatric Intensive Care Unit of a Tertiary Care Hospital

Farrukh¹,

Masood²,

Shakoor³

et al. 2021

PJMHS

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“…Mild QTc prolongation has been reported in four patients (range: 450–454 ms) after risperidone initiation. 77 80 Two of the four patients also had documented electrolyte abnormalities and were receiving additional QTc prolonging medications at the time risperidone was initiated. No other adverse effects have been reported.…”

Section: Treatmentmentioning

confidence: 99%

Assessment and Management of Delirium in the Pediatric Intensive Care Unit: A Review

Liviskie

McPherson

Luecke

2021

J Pediatr Intensive Care

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Many critically ill patients suffer from delirium which is associated with significant morbidity and mortality. There is a paucity of data about the incidence, symptoms, or treatment of delirium in the pediatric intensive care unit (PICU). Risk factors for delirium are common in the PICU including central nervous system immaturity, developmental delay, mechanical ventilation, and use of anticholinergic agents, corticosteroids, vasopressors, opioids, or benzodiazepines. Hypoactive delirium is the most common subtype in pediatric patients; however, hyperactive delirium has also been reported. Various screening tools are validated in the pediatric population, with the Cornell Assessment of Pediatric Delirium (CAPD) applicable to the largest age range and able to detect signs and symptoms consistent with both hypo- and hyperactive delirium. Treatment of delirium should always include identification and reversal of the underlying etiology, reserving pharmacologic management for those patients without symptom resolution, or with significant impact to medical care. Atypical antipsychotics (olanzapine, quetiapine, and risperidone) should be used first-line in patients requiring pharmacologic treatment owing to their apparent efficacy and low incidence of reported adverse effects. The choice of atypical antipsychotic should be based on adverse effect profile, available dosage forms, and consideration of medication interactions. Intravenous haloperidol may be a potential treatment option in patients unable to tolerate oral medications and with significant symptoms. However, given the high incidence of serious adverse effects with intravenous haloperidol, routine use should be avoided. Dexmedetomidine should be used when sedation is needed and when clinically appropriate, given the positive impact on delirium. Additional well-designed trials assessing screening and treatment of PICU delirium are needed.

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Cardiac safety of antipsychotic medications in pediatric and adolescent population: a systematic review and pathways for future research

Gasparini,

Senese,

Scuma

et al. 2024

Eur J Pediatr

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Evaluation of QTc Interval Effects of Antipsychotic Medications for Intensive Care Unit Delirium in Pediatric Patients

Cited by 4 publications

References 25 publications

Outcome and Incidence of Hypomagnesemia in Children Admitted in Pediatric Intensive Care Unit of a Tertiary Care Hospital

Outcome and Incidence of Hypomagnesemia in Children Admitted in Pediatric Intensive Care Unit of a Tertiary Care Hospital

Assessment and Management of Delirium in the Pediatric Intensive Care Unit: A Review

Cardiac safety of antipsychotic medications in pediatric and adolescent population: a systematic review and pathways for future research

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