Case report: Pulmonary hypertensive crisis leading to cardiac arrest during endoscopic evaluation in a 6-year-old boy with autism, severe malnutrition, and undiagnosed scurvy
Pediatric gastroenterologists are often responsible for the evaluation of malnutrition in the setting of selective eating. Endoscopic evaluation for conditions including eosinophilic esophagitis and celiac disease can help to identify and treat mucosal disease contributing to food selectivity. Howev...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2022-10-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fped.2022.1008507/full |
| _version_ | 1811326318144389120 |
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| author | Laura A. Quinn Stephanie P. Gilley Allison D. Ta Benjamin S. Frank Carolyn B. Foley Jaime M. Moore |
| author_facet | Laura A. Quinn Stephanie P. Gilley Allison D. Ta Benjamin S. Frank Carolyn B. Foley Jaime M. Moore |
| author_sort | Laura A. Quinn |
| collection | DOAJ |
| description | Pediatric gastroenterologists are often responsible for the evaluation of malnutrition in the setting of selective eating. Endoscopic evaluation for conditions including eosinophilic esophagitis and celiac disease can help to identify and treat mucosal disease contributing to food selectivity. However, undiagnosed micronutrient deficiencies can cause cardiovascular derangements that significantly increase a patient's anesthetic risk. Vitamin C deficiency in particular, alone or in combination with severe malnutrition, is associated with a severe but reversible form of pulmonary arterial hypertension that, while life threatening in the acute phase, may significantly improve within days of starting ascorbic acid replacement therapy. Here we present a case of a 6-year-old boy with autism spectrum disorder (ASD), severe malnutrition, and undiagnosed chronic vitamin C deficiency who developed a pulmonary hypertensive crisis after induction of general anesthesia leading to cardiac arrest during endoscopic evaluation. While the association between food selectivity among youth with neurodevelopmental differences and vitamin C deficiency is well-described, and pulmonary hypertension is a recognized rare complication of scurvy, extant literature has not addressed next steps to improve patient outcomes. Using this case report as a foundation, we discuss specific patient populations to screen and treat for micronutrient deficiencies prior to anesthesia and propose a novel clinical algorithm for pre-anesthesia risk stratification and mitigation in patients specifically at risk for scurvy and associated pulmonary hypertension. |
| first_indexed | 2024-04-13T14:47:51Z |
| format | Article |
| id | doaj.art-3a56bef535b44d0bb82c540e18143470 |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-04-13T14:47:51Z |
| publishDate | 2022-10-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-3a56bef535b44d0bb82c540e181434702022-12-22T02:42:41ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602022-10-011010.3389/fped.2022.10085071008507Case report: Pulmonary hypertensive crisis leading to cardiac arrest during endoscopic evaluation in a 6-year-old boy with autism, severe malnutrition, and undiagnosed scurvyLaura A. Quinn0Stephanie P. Gilley1Allison D. Ta2Benjamin S. Frank3Carolyn B. Foley4Jaime M. Moore5Department of Pediatrics, Section of Pediatric Gastroenterology, Hepatology and Nutrition, University of Colorado School of Medicine, Aurora, CO, United StatesDepartment of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, United StatesDepartment of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, United StatesDepartment of Pediatrics, Section of Cardiology, University of Colorado School of Medicine, Aurora, CO, United StatesDepartment of Anesthesiology, Division of Pediatric Anesthesiology, University of Colorado School of Medicine, Aurora, CO, United StatesDepartment of Pediatrics, Section of Nutrition, University of Colorado School of Medicine, Aurora, CO, United StatesPediatric gastroenterologists are often responsible for the evaluation of malnutrition in the setting of selective eating. Endoscopic evaluation for conditions including eosinophilic esophagitis and celiac disease can help to identify and treat mucosal disease contributing to food selectivity. However, undiagnosed micronutrient deficiencies can cause cardiovascular derangements that significantly increase a patient's anesthetic risk. Vitamin C deficiency in particular, alone or in combination with severe malnutrition, is associated with a severe but reversible form of pulmonary arterial hypertension that, while life threatening in the acute phase, may significantly improve within days of starting ascorbic acid replacement therapy. Here we present a case of a 6-year-old boy with autism spectrum disorder (ASD), severe malnutrition, and undiagnosed chronic vitamin C deficiency who developed a pulmonary hypertensive crisis after induction of general anesthesia leading to cardiac arrest during endoscopic evaluation. While the association between food selectivity among youth with neurodevelopmental differences and vitamin C deficiency is well-described, and pulmonary hypertension is a recognized rare complication of scurvy, extant literature has not addressed next steps to improve patient outcomes. Using this case report as a foundation, we discuss specific patient populations to screen and treat for micronutrient deficiencies prior to anesthesia and propose a novel clinical algorithm for pre-anesthesia risk stratification and mitigation in patients specifically at risk for scurvy and associated pulmonary hypertension.https://www.frontiersin.org/articles/10.3389/fped.2022.1008507/fullscurvypulmonary hypertension (PAH)ARFIDautismvitamin C deficiencyrisk stratifcation |
| spellingShingle | Laura A. Quinn Stephanie P. Gilley Allison D. Ta Benjamin S. Frank Carolyn B. Foley Jaime M. Moore Case report: Pulmonary hypertensive crisis leading to cardiac arrest during endoscopic evaluation in a 6-year-old boy with autism, severe malnutrition, and undiagnosed scurvy Frontiers in Pediatrics scurvy pulmonary hypertension (PAH) ARFID autism vitamin C deficiency risk stratifcation |
| title | Case report: Pulmonary hypertensive crisis leading to cardiac arrest during endoscopic evaluation in a 6-year-old boy with autism, severe malnutrition, and undiagnosed scurvy |
| title_full | Case report: Pulmonary hypertensive crisis leading to cardiac arrest during endoscopic evaluation in a 6-year-old boy with autism, severe malnutrition, and undiagnosed scurvy |
| title_fullStr | Case report: Pulmonary hypertensive crisis leading to cardiac arrest during endoscopic evaluation in a 6-year-old boy with autism, severe malnutrition, and undiagnosed scurvy |
| title_full_unstemmed | Case report: Pulmonary hypertensive crisis leading to cardiac arrest during endoscopic evaluation in a 6-year-old boy with autism, severe malnutrition, and undiagnosed scurvy |
| title_short | Case report: Pulmonary hypertensive crisis leading to cardiac arrest during endoscopic evaluation in a 6-year-old boy with autism, severe malnutrition, and undiagnosed scurvy |
| title_sort | case report pulmonary hypertensive crisis leading to cardiac arrest during endoscopic evaluation in a 6 year old boy with autism severe malnutrition and undiagnosed scurvy |
| topic | scurvy pulmonary hypertension (PAH) ARFID autism vitamin C deficiency risk stratifcation |
| url | https://www.frontiersin.org/articles/10.3389/fped.2022.1008507/full |
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