Uvula deviation, sore throat, fever? Learn all about peritonsillar abscesses in this episode!

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This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Dean Blumberg (UC Davis pediatric infectious disease). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

Key Points:

• Peritonsillar abscess (PTA) is a suppurative infection of the tissue between the palatine tonsil capsule and the pharyngeal muscles
• Symptoms include fever, sore throat, uvular deviation, trismus, voice changes, drooling, unilateral tonsillar swelling with deviation of the uvula to the contralateral side
• Diagnosis can be clinical but imaging is often obtained
• Treat with antibiotics (empiric amoxicillin, cephalosporin, or clindamycin but adjust based on cultures) and incision and drainage

Sources:

• A Clinical Approach to Tonsillitis, Tonsillar Hypertrophy, and Peritonsillar and Retropharyngeal Abscesses. R Bochner, et al. Pediatrics in Review (2017) 38 (2): 81–92. https://doi.org/10.1542/pir.2016-0072

Marijuana, cannabis, THC, and CBD are among the many common words and forms of cannabis that pediatric patients are being exposed to in our current day and age. Keep up to date about the official AAP policy and recommendations with today's episode.

Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bluesky.social, and connect with us at pediagogypod@gmail.com

This episode was written by pediatricians Tammy Yau and Lidia Park. Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

Key Points:

• At the time of this episode release, marijuana is considered a schedule I drug at the federal level meaning here is high potential for abuse, no medical use, and/or lack of safety with using this drug. The official AAP stance is to avoid cannabinoid use in most children. More studies need to be done to determine the long term effects.
• Cannabis plants generally have both THC and CBD which are types of cannabinoids. THC can cause intoxication, analgesia, and antiemesis. CBD is less intoxicating and anxiolytic.
• Cannabis intoxication can cause tachycardia, hypertension, red eyes, dry mouth, orthostatic hypotension, increased appetite and thirst, drowsiness, insomnia, anxiety, short term memory loss, ataxia, stroke, nystagmus, hypothermia, hypotonia, and rarely respiratory depression. Treatment is supportive.
• THC can be detected in breastmilk. There is not enough information about long term safety and implications of THC exposure in utero or while breastfeeding.
• In children, epidiolex is the only plant derived cannabinoid FDA approved for use of severe seizures in children.

Sources:

• Ammerman S, et al. The impact of marijuana policies on youth: clinical, research, and legal update. Pediatrics. 2015 Mar 1;135(3):e769-85. doi: 10.1542/peds.2014-4146
• Hale’s Medications & Mothers’ Milk 2023: A Manual of Lactational Pharmacology
• Fischedick J, Van Der Kooy F, Verpoorte R. Cannabinoid receptor 1 binding activity and quantitative analysis of Cannabis sativa L. smoke and vapor. Chem Pharm Bull (Tokyo). 2010;58(2):201-207. doi:10.1248/cpb.58.201

Don't miss this cause of anemia in your differential in today’s episode about autoimmune hemolytic anemia!

Follow us on Twitter/X @Pediagogypod, Instagram/Threads @pediagogy, Bluesky @pediagogypodcast.bsky.social, and connect with us at pediagogypod@gmail.com

This episode was written by pediatricians Tammy Yau and Lidia Park with content support from Anjali Pawar (UC Davis pediatric hematology). Pediatricians Tammy and Lidia take full responsibility for any errors or misinformation.

Key Points:

• Autoimmune hemolytic anemia is an extravascular hemolysis
• Symptoms can include pallor, fatigue, lightheadedness, jaundice, tachycardia, acrocyanosis, dark urine, splenomegaly, and gallstones with labs showing anemia with schistocytes, reticulocytosis, hyperbilirubinemia, elevated LDH, elevated AST, and positive Coombs testing.
• AIHA can be triggered by infections, underlying autoimmune diseases, malignancy, immunosuppression, and medications.
• Treatment is steroids or rituximab for warm AIHA and avoiding the cold for cold AIHA. In refractory cases, splenectomy or stem cell transplant may be needed. Transfusions are generally not recommended due to ongoing hemolysis unless anemia is severe.

Sources:

• Voulgaridou A, Kalfa TA. Autoimmune Hemolytic Anemia in the Pediatric Setting. J Clin Med. 2021;10(2):216. Published 2021 Jan 9. doi:10.3390/jcm10020216
• Noronha, Suzie A. "Acquired and congenital hemolytic anemia." Pediatrics in Review 37.6 (2016): 235-246. doi: 10.1542/pir.2015-0053