Pediatric emergency medicine trisk 1535 1535
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adrenal hyperplasia is a rare but life-threatening cause of frequency. Excessive
urinary excretion of sodium leads to marked dehydration with hyponatremia.
Female infants may exhibit virilization of the external genitalia. Male infants may
demonstrate increased pigmentation of the external genitalia and/or a relatively
enlarged phallus.
Drugs and Toxins
Drugs are a relatively common cause of frequency in adolescence.
Methylxanthines (caffeine, theophylline) and ethanol inhibit the production of
antidiuretic hormone. In addition to caffeinated drinks (soft drinks, coffee, black
teas, energy drinks), chocolate is another source of caffeine. Diuretic agents, such
as furosemide or hydrochlorothiazide, can cause frequency when ingested other
intentionally or accidentally. Lithium and vitamin D are also associated with
urinary frequency, interfering with renal responsiveness to antidiuretic hormone.
Many other medications may cause frequency, and a pharmacologic history
should be obtained in the child who presents with urinary frequency.
Psychogenic
Frequency may be a presenting symptom of water intoxication leading to
polyuria. Patients do not have nocturia, as enuresis is related to excessive fluid
intake. The serum sodium and osmolality may be decreased. Psychogenic
polydipsia is an extremely unusual diagnosis in young children but may present in
adolescence. Water intoxication secondary to Munchausen syndrome by proxy, an
unusual presentation of abuse in the younger child, is also a consideration. The
“extraordinary urinary frequency syndrome” can cause urinary frequency in
pediatric patients. Average age of onset is 6 years (with a range of about 2 to 11
years). Daytime frequency occurs as often as every 5 minutes. Nocturia is present
in about half the cases but usually occurs only about one to two times per night.
Generally, only reassurance is needed, as this often resolves spontaneously within
about 2 months (although in some children, the duration of symptoms can be
markedly longer). The etiology is unclear, but often has a psychogenic
component, with an apparent “trigger” (school problems, parental death, sibling
illness, etc.) identifiable in about half the cases. After consultation, a trial of
extended-release oxybutynin, behavior modification, and/or biofeedback
techniques are therapeutic considerations.
EVALUATION AND DECISION
The primary role of the emergency physician in evaluating the child with urinary
frequency is to exclude significant underlying pathology that may result in
