Post-publication Peer Review (P3R) is an online forum for ongoingreview peer review. To submit a P3R please go to the article you wish to respond to and click on the link that reads "P3Rs: Submit a Response." Submission of P3Rs are open to all health care professionals and experts in related fields.

Post-publication Peer Reviews to:

ELECTRONIC ARTICLE:
Manish J. Butte, Bac X. Nguyen, Tim J. Hutchison, James W. Wiggins, and James W. Ziegler
Pediatric Myocardial Infarction After Racemic Epinephrine Administration
Pediatrics 1999; 104: e9 [Abstract] [Full text] [PDF]
*P3Rs: Submit a response to this article

P3Rs published:

[Read P3R] Possibility of prior coronary arteritis as a cause fo the MI
Sanjay Prabhu   (15 July 1999)
[Read P3R] Hypoxia with vasospasm may be the cause of MI
Yalamanchali Chowdary   (25 August 1999)

Possibility of prior coronary arteritis as a cause fo the MI 15 July 1999
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Sanjay Prabhu,
Paediatrics resident
Sheffield Children's Hospital

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Re: Possibility of prior coronary arteritis as a cause fo the MI

drsanjuuk{at}yahoo.com Sanjay Prabhu

This was an excellent case report. There was however no mention of the fact whether there had been a history in the past suggestive of atypical Kawasaki's disease in early childhood which may have led to some changes in the coronary artery wall making it more likely to respond like it did.This could be another explanation for the clinical response.
Hypoxia with vasospasm may be the cause of MI 25 August 1999
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Yalamanchali Chowdary,
Pediatric pulmonologist
Lutheran Hospital

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Re: Hypoxia with vasospasm may be the cause of MI

ychowdary{at}pol.net Yalamanchali Chowdary

Your patient had a oxygen saturation of 80% in room air. The patient was given oxygen and the treatments helped to improve oxygen saturation to 92%. What was the mode of oxygen delivery and what percentage of oxygen was used. This child is already hypoxic by your description. The possibility of MI will always be there if you use racemic epinephrine or any form of epinephrine in the presence of hypoxia for obvious reasons. In my view I never use racemic epinephrine if the oxygen saturartion in room air is that low and does not come up despite 100 % supplemental oxygen because of potential cardiotoxic effects. I think you should have intubated him right away than using racemic epinephrine. We all know epinephrine is not a benign drug and should be used properly and carefully.We need to select our patients for judicious use of this medication.