Ashen Skin

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From the original on 12 December 2017. 22 October 2013. From the original on 1 January 2018. Retrieved 16 July 2018. Chip hailstone. 2 November 2015.

Gray baby syndrome (also termed Gray or Grey syndrome) is a rare but serious side effect that occurs in newborn infants (especially premature babies) following the accumulation of antibiotic chloramphenicol.^[1]

Signs and symptoms[edit]

Toxic levels of chloramphenicol after 2–9 days result in:

• Loss of appetite
• Vomiting
• Ashen gray color of the skin
• Hypotension (low blood pressure)
• Cyanosis (blue discolouration of lips and skin)
• Hypotonia
• Abdominal distension
• Irregular respiration
• Increased blood lactate

Pathophysiology[edit]

Two pathophysiologic mechanisms are thought to play a role in the development of gray baby syndrome after exposure to the anti-microbial drug chloramphenicol. This condition is due to a lack of glucuronidation reactions occurring in the baby, thus leading to an accumulation of toxic chloramphenicol metabolites:^[2]

1. The UDP-glucuronyl transferase enzyme system of infants, especially premature infants, is immature and incapable of metabolizing the excessive drug load.
2. Insufficient renal excretion of the unconjugated drug.

Insufficient metabolism and excretion of chloramphenicol leads to increased blood concentrations of the drug, causing blockade of the electron transport in the liver, myocardium, and skeletal muscles, resulting in the above symptoms.

Diagnosis[edit]

Gray baby syndrome should be suspected in a new born with abdominal distension, progressive pallid cyanosis, irregular respirations, and refusal to breastfeed, especially if the mother used chloramphenicol in the last days of her third trimester.

Prevention[edit]

The condition can be prevented by using chloramphenicol at the recommended doses and monitoring blood levels,^[3][4][5] or alternatively, third generation cephalosporins can be effectively substituted for the drug, without the associated toxicity.^[6]

Treatment[edit]

Chloramphenicol therapy should be stopped immediately. Exchange transfusion may be required to remove the drug. Sometimes, phenobarbital (UGT induction) is used.

References[edit]

1. ^McIntyre J, Choonara I (2004). 'Drug toxicity in the neonate'. Biol Neonate. 86 (4): 218–21. doi:10.1159/000079656. PMID15249753.
2. ^Brunton, Laurence L.; Lazo, John S.; Parker, Keith, eds. (2005). 'Chapter 46. Protein Synthesis Inhibitors and Miscellaneous Antibacterial Agents'. Goodman & Gilman's The Pharmacological Basis of Therapeutics (11th ed.). New York: McGraw-Hill. ISBN0-07-142280-3.
3. ^Feder H (1986). 'Chloramphenicol: what we have learned in the last decade'. South Med J. 79 (9): 1129–34. doi:10.1097/00007611-198609000-00022. PMID3529436.
4. ^Mulhall A, de Louvois J, Hurley R (1 January 1983). 'Chloramphenicol toxicity in neonates: its incidence and prevention'. British Medical Journal (Clinical research ed.). 287 (6403): 1424–7. doi:10.1136/bmj.287.6403.1424. PMC1549666. PMID6416440.
5. ^Forster J, Hufschmidt C, Niederhoff H, Künzer W (1985). '[Need for the determination of chloramphenicol levels in the treatment of bacterial-purulent meningitis with chloramphenicol succinate in infants and small children]'. Monatsschr Kinderheilkd. 133 (4): 209–13. PMID4000136.
6. ^Aggarwal, R; Sarkar, N; Deorari, AK; Paul, VK (Dec 2001). 'Sepsis in the newborn'. Indian journal of pediatrics. 68 (12): 1143–1147. doi:10.1007/BF02722932. PMID11838570.

Further reading[edit]

• Krasinski, K; Perkin, R; Rutledge, J (1 September 1982). 'Gray Baby Syndrome Revisited'. Clinical Pediatrics. 21 (9): 571–572. doi:10.1177/000992288202100910. PMID7105617.
• Feigin RD, Cherry JD, Demmler-Harrison GJ, Kaplan SL, eds. (2009). 'Ch.248. Antibacterial therapeutic agents'. Feigin & Cherry's textbook of pediatric infectious diseases (6th ed.). Philadelphia, PA: Saunders/Elsevier. ISBN1416040447.

External links[edit]

The skin is an easily observed indicator of the peripheral circulation and perfusion, blood oxygen levels, and body temperature.

The skin color, temperature, and condition are good indicators of the patient’s condition and circulatory status. They may also be good initial indicators of heat or cold injuries. This initial indicator should always be confirmed, when time permits, with a core body temperature (see Lesson 2).

a. Color.

(1) Many blood vessels lie near the surface of the skin.

(2) Pigmentation in individuals will not hide changes in the skin’s underlying color.

(3) In lightly pigmented individuals, skin normally has a pink color.

(4) In patients with deeply pigmented skin, changes in skin color may only be apparent in certain areas, such as the fingernail beds, the lips, the mucous membranes in the mouth, the underside of the arm and hand, and the conjunctiva of the eye.

(5) Poor peripheral circulation will cause the skin to appear pale, white, ashen, gray, or waxy and translucent like a white candle. These skin colors can also appear in abnormally cold or frozen skin.

(6) When the blood is not properly saturated with oxygen, it changes to a bluish color. Skin over the blood vessels appears blue or gray, a condition called cyanosis. Destruction derby raw ps1 rom.

(7) Red skin will result from carbon monoxide poisoning, significant fever, heatstroke, sunburn, mild thermal burns, or other conditions in which the body is unable to properly dissipate heat.

(8) Color changes may also result from chronic illness. Liver disease dysfunction may cause jaundice, resulting in a yellow cast to the skin.

b. Temperature.

(1) Normally, the skin is warm to the touch.

(2) The skin feels hot with significant fever, sunburn, or hyperthermia.

(3) The skin feels cool in early shock, profuse sweating, heat exhaustion, and profound hypothermia and/or frostbite.

(4) Feel the patient’s forehead with the back of your ungloved hand to determine marked fever.

c. Moisture.

(1) The skin is normally dry.

(2) Wet, moist, or excessively dry and hot skin is considered abnormal.

(3) In descriptions of the skin, it is usually listed as color, condition, and temperature (CCT).

d. Capillary Refill.

Capillary refill can be assessed as part of the evaluation of the skin.

(1) Capillary refill is used to evaluate the ability of the circulatory system to restore blood to the capillary system (perfusion). Capillary refill is used primarily in the assessment of pediatric patients. Refill time in adults is not considered as accurate due to differences in circulation from medications and various other factors. This can still be used as a simple test of perfusion to the extremities, but many factors must be considered, such as the age of the patient and the environment (cold will decrease capillary refill time).

(2) Capillary refill is evaluated at the nail bed in a finger.

(a) Place your thumb on the patient’s fingernail and gently compress.

(b) Pressure forces blood from the capillaries.

(c) Release the pressure and observe the fingernail.

(d) As the capillaries refill, the nail bed returns to its normal deep pink color.

(e) Capillary refill should be both prompt and pink.

(f) Color in the nail bed should be restored within 2 seconds, about the time it takes to say “capillary refill.”