Pediatric emergency medicine trisk 0997 0997
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FIGURE 50.1 Evaluation and decision for unusual odors. DKA, diabetic ketoacidosis.
A physiologic odor that often heralds the onset of puberty emanates from the
underarms. This is usually the earliest sign of puberty and precedes all other
physical changes. Age of onset is around 6 to 8 years and reflects the onset of
adrenarche. Dehydroepiandrosterone sulfate is the androgen believed to be
responsible for the pungent aroma of underarm body odor and can be measured
for confirmation. Although the adrenal and hypothalamic–pituitary–gonadal axes
are separate systems involved with the onset of puberty, they often become active
nearly simultaneously.
EVALUATION AND DECISION
The evaluation of a child who presents to the ED should incorporate all the
senses, including smell ( Fig. 50.1 ). Both presence and absence of odors can be
diagnostic. Each person has a unique odor, ranging from pleasant to offensive.
Using the sense of smell should be done in stages; an initial evaluation of the
prevailing odor of the examination room, followed by attention to overall body
odor and identification of odors from individual orifices and body fluids. Body
fluids such as ocular, ear, nasal, sinus tract, or umbilical drainage, vomitus,
sputum, genital discharge, stool, ulcers, and superinfection of the dermis have
unique identifiable odors.
Good or poor hygiene is readily detected in a closed examination room. When
an unusual odor is detected, the history should include information about
medications (topical, oral, or rectal), onset and duration of odor, methods used to
