title: [Multiple organ failure in a severely malnourished patient with chromosome aberration].
abstract: BACKGROUND
  Pneumonia and malnutrition are two of the biggest killers in childhood, as defined by the World Health Organisation. Although common in the developing world, these conditions can also be observed in more advanced countries, as a result of negligence and lack of proper care in disabled children. We describe a case in which severe malnutrition resulted in multiple organ failure.
  
  
  METHODS
  A 16-yr-old retarded girl with +14q chromosome aberration, was admitted to hospital because of severe anaemia and dyspnea. She was extremely malnourished. Her body weight was 32 kg with a height of 152 cm (BMI 13.9). Her Hb concentration was 1.12 mmol L(-1), Ht 7%, and RBC 0.93 T L(-1). RBC transfusion resulted in transfusion-related acute lung injury (TRALI) and multiple organ failure. She was treated with mechanical ventilation, inotropic support and parenteral nutrition, complicated by the refeeding syndrome and gastrointestinal haemorrhage. After recovery, a gastrostomy was performed, but due to gastric retention she required a laparotomy for adhesiolysis.The girl recovered and remains under home care.
  
  
  CONCLUSIONS
  In a case of a girl with retardation, multiple organ failure resulting from ten years of malnutrition was observed. She was especially difficult to treat because of a prolonged dysfunction of homeostasis, hypoproteinemia, hypophosphatemia and SIRS. Such patients require careful treatment in ICU settings.
authors.affiliation: Oddział Kliniczny Anestezjologii i Intensywnej Terapii dla Dzieci Collegium Medium UMK w Bydgoszczy. kikanest@cm.umk.pl
authors.forename: Roman
authors.initials: R
authors.lastname: Kaźmirczuk
authors.forename: Marlena
authors.initials: M
authors.lastname: Jakubczyk
authors.forename: Sylwia
authors.initials: S
authors.lastname: Kołtan
authors.forename: Piotr
authors.initials: P
authors.lastname: Brzeziński
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Szkulmowski
authors.forename: Kinga
authors.initials: K
authors.lastname: Kupczyk
authors.forename: Piotr
authors.initials: P
authors.lastname: Skiba
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Apanasiewicz
authors.forename: Mariusz
authors.initials: M
authors.lastname: Mielniczuk
authors.forename: Marcin
authors.initials: M
authors.lastname: Owczarek
authors.forename: Mieczysława
authors.initials: M
authors.lastname: Czerwionka-Szaflarska
authors.forename: Mariusz
authors.initials: M
authors.lastname: Wysocki
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Kusza
mesh_terms: D000293:Adolescent; D002869:Chromosome Aberrations; D002883:Chromosomes, Human, Pair 14; D005260:Female; D006801:Humans; D008607:Intellectual Disability / Q000150:complications; D044342:Malnutrition / Q000150:complications* / Q000628:therapy; D009102:Multiple Organ Failure / Q000209:etiology* / Q000628:therapy