Pediatric emergency medicine trisk 1856 1856
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DKA/Hyperglycemia
1% of children with diabetic ketoacidosis will develop clinically significant cerebral
edema
Risk factors for cerebral edema include elevated blood urea nitrogen, low Pco2 ,
treatment with bicarbonate, failure of serum Na to rise steadily with correction of
hyperglycemia, age <3 years, new-onset diabetes
Hyperglycemia in ED setting can result from numerous triggers including
intercurrent illness or trauma in patient with known DM, new-onset DM, other
illnesses associated with hyperglycemia, spurious sample, medication effect
Hypoglycemia
Prompt recognition of hypoglycemia is important to avoid adverse outcomes
Hypoglycemia in absence of ketones is consistent with hyperinsulinism or fatty acid
oxidation enzyme deficiencies
Hypopituitarism
The acute presentation of hypopituitarism is most likely to occur when the child is
stressed by injury, illness, or fasting
Children with hypopituitarism are prone to hypoglycemia
Congenital hypopituitarism is associated with intracranial developmental anomalies
or lesions
Adrenal Insufficiency/Congenital Adrenal Hyperplasia
Cortisol and aldosterone replacement in patients with primary adrenal insufficiency
under stress conditions is imperative
ED presentations include Addisonian crisis, ambiguous genitalia, acute saltwasting crisis, and precocious puberty
Patients with acute salt-wasting crisis must be recognized and treated immediately
with fluid resuscitation, stress dose hydrocortisone, careful monitoring of
electrolytes
Pheochromocytoma
Often presents with headache, palpitations, sweating; but also nervousness,
tremulousness, fatigue, chest/abdominal pain, and flushing
Most associated with hypertension although can be paroxysmal; alpha blockade is
antihypertensive of choice, avoid pure beta blockade as can lead to severe
hypertension
Diabetes Insipidus
Inability of kidneys to concentrate urine resulting in polyuria/polydipsia
Hypertonic dehydration if thirst is not intact or access to fluids is restricted; if occurs
abruptly, patient at risk for central pontine myelinolysis
Consider in patients with increased urine excretion, enuresis, and increased thirst
