Pediatric emergency medicine trisk 0879 0879
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Glucose
Liver enzymes, which do not reflect liver function but can identify liver
injury/irritation, include:
Aspartate aminotransferase (AST)
Alanine aminotransferase (ALT)
The above two may also be high in states of muscle breakdown
Gamma glutamyltransferase (GGT)
Conjugated bilirubin
Total bilirubin
A decreased platelet count, in conjunction with examination of spleen size and
stigmata of portal hypertension, point to portal hypertension and indicate a more
chronic process.
For any child with evidence of liver failure, admission to the pediatric intensive
care unit in consultation with a gastroenterologist or hepatologist is warranted. If
not in failure, the age of the child and clinical evaluation should dictate further
emergency department, inpatient versus outpatient evaluation and management.
EVALUATION OF THE NEONATE
For an infant under 2 months of age with conjugated hyperbilirubinemia, sepsis
should always be considered. If any concerning features arise during the history
or physical examination, a sepsis evaluation is warranted. Depending on the
concern, this could include cultures blood, urine, and cerebrospinal fluid, as well
as a complete blood cell, platelet count, blood urea nitrogen level, creatinine
level, and blood sugar tests. Urine should also be obtained for urinalysis.
For these young infants, as well as children up to 12 months of age, statemandated metabolic screens obtained during the newborn period should be
reviewed. Additional studies of blood and urine that may be useful include
protease inhibitor (PI) typing (for α1 -antitrypsin disease), TORCHS and hepatitis
B virus serology, serum amino acids, thyroid function tests, red blood cell
galactose 1-phosphate uridyltransferase activity, and urine examination for
cytomegalovirus (CMV). Useful imaging includes chest radiograph to detect
butterfly vertebrae characteristic of Alagille syndrome, and abdominal ultrasound
to detect choledochal cysts. If BA is suspected, a more specialized evaluation is
needed (see Biliary Atresia section, page 292). Inpatient observation is
appropriate in this age group because the diagnosis can rarely be established in
