Lupin beans are the yellow legume seeds of the genus Lupinus. They are traditionally eaten as a pickled snack in many countries. Bitter lupin beans have a high amount of alkaloids called lupanine. Because the alkaloid is responsible for anticholinergic toxidrome, the beans should pass a debittering process before consumption. Only few pediatric cases of lupin bean intoxication were reported. We present a 12-year-old boy who visited the emergency department for the unexpected onset of anticholinergic toxidrome.

Objective: In this study, we aimed to evaluate the effects of decompressive craniectomy (DC) on the brain death (BD) determination process in the pediatric intensive care unit (PICU). Materials and Methods: All children who were diagnosed with BD in the PICU between 2009 and 2020 were included in this study. Patient demographics, causative mechanisms, BD examinations, and ancillary tests used were recorded. The time intervals (from PICU admission to first BD examination, from first BD examination to BD diagnosis) and number of BD examinations were compared between patients with and without DC. Results: During the study period, 70 pediatric cases were diagnosed with BD among 513 total deaths (13.6%). Their median age was 54.5 months [interquartile range (IQR): 24-140]. Transcranial Doppler ultrasound (TCD) was performed in 66 patients (94.3%). The most common combination of ancillary tests was the apnea test and TCD combination, which was performed in 56 patients (80%). Thirty-four children (48.6%) experienced immediate surgery for DC. Patients with DC had a higher median number of BD examinations than patients without DC [3 (IQR: 2-3) vs. 2 (IQR: 1-2), P < .001]. The patients with DC had a longer time interval between the first examination and declaration of BD than patients without DC [45.5 hours (IQR: 21.7-91.7) versus 15 hours (IQR: 2-31.2), P < .006]. Conclusion: Decompressive craniectomy may complicate BD determination and cause challenges for brain death diagnosis based on cerebral flow imaging techniques. The lack of specific recommendations for this patient group in the guidelines causes a delayed diagnosis of BD. Cite this article as: Ekici B, Ersayoğlu İ, Yazıcı Özkaya P, et al. Impact of decompressive craniectomy on diagnosing brain death in children. Turk Arch Pediatr. 2024;59(1):93-97.

Background. Acute respiratory failure is a prevalent condition in childhood with a high rate of mortality. Invasive mechanical ventilation support may be required for the management of these patients. Extracorporeal membrane oxygenation (ECMO) is a method used when ventilation support is insufficient. However, the less invasive extracorporeal carbon dioxide removal method can be used as an alternative in cases of hypercapnic respiratory failure. Case. A 9-year-old patient with cystic fibrosis presented to the hospital with acute respiratory failure due to pneumonia. Bilateral patchy areas of consolidation were evident in the chest x-ray. Invasive mechanical ventilation support was consequently provided to treat severe hypercapnia. Although peak and plateau pressure levels exceeded 32 cmH₂O (49 cmH₂O) and 28 cmH₂O (35 cmH₂O), respectively, the patient continued to have severe respiratory acidosis. Therefore extracorporeal carbon dioxide removal support was initiated to provide lung-protective ventilation. By Day 10, venovenous ECMO support was initiated due to deteriorating oxygenation. Conclusion. In cases where conventional invasive mechanical ventilation support is insufficient due to acute hypercapnic respiratory failure, extracorporeal carbon dioxide removal support, which is less invasive compared to ECMO, should be considered as an effective and reliable alternative method. However, it should be noted that extracorporeal carbon dioxide removal support does not affect oxygenation; it functions solely as a carbon dioxide removal system.

Calcium channel blockers (CCBs’) and angiotensin receptor blockers (ARBs’) are widely used in clinical practice and are easily available. Intoxication with these drugs results in life-threatening deep vasoplegic shock, making them particularly dangerous, especially for children. Here, we report two patients who ingested amlodipine and irbesartan for suicidal attempts and were unresponsive to all conventional treatments. They were placed on venoarterial extracorporeal membrane oxygenation (VA-ECMO) and hemodynamically stable immediately after extracorporeal life support (ECLS). Patients were successfully decannulated and extubated. CCB and ARB poisoning that are resistant to medical therapy can be treated by ECLS successfully.