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- Title
CONSIDERAŢII PE MARGINEA TRATAMENTULUI DISLIPIDEMIEI LA COPIL. PREZENTARE DE CAZ.
- Authors
Dobrescu, Andreea; Mărăzan, Monica; Pienar, Corina; Miele, Ioana
- Abstract
Introduction: About 75% of medicines, including lipid-lowering therapy, don't have clinical trials in children, a major disadvantage for pediatrics. Aim: To present a case of primary dyslipidemia homozygous mixed form with pathogenic therapy in children. Material and Method: A 2 year and 7 months old girl diagnosed with mixed dyslipidemia (triglycerides (TG) = 1490 mg/dl, cholesterol = 864 mg/dl) during a gastrointestinal disease. Clinically, she had eruptive xanthomas. We evaluated the serum aspect and we determined the lipid fractions using the photometric method. Results: Hypolipidic treatment was initiated for 3 months but cholesterol and TG were maintained particularly high for age. After this period, we started the statin therapy and we obtained lower cholesterol without any side effects (transaminases, GGT, CPK had normal values). The treatment was supplemented with fibrates 5 months later due to persistent hypertriglyceridemia (a medium value of 1636.52 mg/dl). Initially, the patients received a low dose (1/2 tablet/day) and we adjusted it according to TG values till 1 tablet/day. Values of lipid fractions decreased during the therapy. The average of cholesterol values measured at approximately every six months was 193.95 mg/dl, HDL-cholesterol 20.60 mg/dl, TG 2688.43 mg/dl. The patient developed a hepatocytolisis syndrome after one year of fibrates treatment at the dose of 1 tablet/day requiring dose reduction. The parents were informed about the treatment and the absence of clinical trials (off-label prescription) in children and signed the informed consent. Discussions: Prescribing an off-label drug in children is different from prescribing a prohibited treatment. PLUTO is a study which highlighted the effectiveness of statins in hypercholesterolemia in over 10 year old children. Conclusions: The extreme values of cholesterol and TG imposed the necessity of specific treatment initiation. The difficulty of maintaining a proper diet explains the lipids fluctuations. The closed values with standard's ones are an indicator of the treatment's effectiveness.
- Subjects
DYSLIPIDEMIA; ANTILIPEMIC agents; GASTROINTESTINAL disease diagnosis; HYPOLIPEMIA; CLINICAL trials; THERAPEUTICS
- Publication
Jurnalul Pediatrului, 2014, Vol 17, p62
- ISSN
2360-4557
- Publication type
Case Study