Pediatric emergency medicine trisk 1860 1860
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Condition
Major clinical
features
Diabetic ketoacidosis
Polyuria, polydipsia, Blood glucose, pH
dehydration,
ketotic breath,
hyperpnea,
nausea, vomiting,
abdominal pain,
coma
0.9% saline 10
mL/kg in first
1–2 hrs IV;
insulin infusion
0.1 Unit/kg/hr;
later, may need
KAcetate 10–60
mEq/L and
KPhos 10–20
mEq/L
Hypoglycemia
Older child : hunger,
sweatiness,
dizziness,
convulsions, coma
Neonate : apnea,
hypotonia,
hypothermia,
irritability, tremor,
convulsions
Ambiguous genitalia
in females; poor
feeding, weight
loss, irritability,
vomiting,
dehydration
Nausea, vomiting,
abdominal pain,
weakness,
malaise,
hypotension,
dehydration,
hyperpigmentation
25% dextrose 1–2
mL/kg IV bolus
or 10% dextrose
5–10 mg/kg/min
IV infusion,
glucagon 0.5–1
mg IM stat (if
hyperinsulinism)
Congenital adrenal
hyperplasia
Adrenal insufficiency
Hypercalcemia
Headache,
(hyperparathyroidism)
irritability,
anorexia,
constipation,
polyuria,
polydipsia,
dehydration,
hypertension
Urgent investigations
Blood glucose
Serum for growth
hormone, cortisol,
insulin; first-voided
urine for organic
acids and toxin
screen
Initial treatment
Plasma sodium,
0.9% saline 20
potassium, glucose,
mL/kg in first
17hour IV;
hydroxyprogesterone;
hydrocortisone
karyotype and pelvic
25 mg IV stat
ultrasound
(neonatal dose)
Plasma sodium,
Hydrocortisone
potassium, glucose,
100 mg IV stat;
cortisol, and ACTH
10% dextrose in
(for retrospective
0.9% saline 20
confirmation of
mL/kg in first
diagnosis)
hour
Plasma calcium,
phosphate
0.9% saline at two
to three times
maintenance
rate; furosemide
1 mg/kg
