Pediatric emergency medicine trisk 1536 1536
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morbidity, identify treatable conditions, and determine appropriate referral when
needed. The nature and quality of the urine should be assessed, including color
(suggesting dilute or concentrated urine), presence of blood (suggesting
nephrolithiasis or intrinsic renal disease), and foul odor (suggestive of an
infectious etiology). Additional history should then focus on elucidating the organ
system principally involved in the etiology of the urinary frequency (see Table
78.1 ). Infectious causes are heralded by dysuria, fever, or flank pain, or may be
suggested with a history of prior UTIs. Abdominal pain can signal a primary
abdominal etiology (such as severe right lower quadrant pain suggesting
appendicitis or severe colicky left lower quadrant pain suggesting ovarian
torsion). Questions related to DM should be included in the history (such as
polydipsia, polyphagia, weight loss, and family history). The presence or absence
of nocturia and enuresis is also an important historical point. Neurologic
complaints can suggest central DI. A thorough stooling history should be
obtained to evaluate for constipation, especially in toddler and school-aged
children. A complete medication and substance use history should be obtained
given the varied toxicologic etiologies of urinary frequency. The last menstrual
period of an adolescent female should be ascertained.
Perform a complete physical examination, including an accurate blood pressure
measurement. The child’s growth parameters should be plotted, and the blood
pressure should be compared with age-specific normal values to screen for
hypertension (see Chapter 37 Hypertension ). Carefully palpate the abdomen for
the presence of abdominal masses and/or tenderness, specifically in the lower
quadrants. Percussion of the flanks should be performed. Examine the
lumbosacral area closely for anomalies (hairy patches, dimples, tracts, etc.).
Special attention should be focused on the function of sacral nerves II to IV (anal
wink and sphincter tone). Unless the diagnosis is readily apparent, a rectal
examination should be performed, noting tone, tenderness, masses, and the
quality and quantity of stool in the rectal vault. The external genitalia should
always be thoroughly examined, meticulously searching for signs of infection,
trauma, or anatomic abnormalities. Signs of virilization (in the female) or
hyperpigmentation (in the male) should be evaluated. A thorough neurologic
examination with careful attention to the retinal fundi and visual fields is
warranted.
The laboratory evaluation of urinary frequency begins with a urinalysis. An
algorithm for interpretation of the urinalysis is shown in Figure 78.1 . If cystitis
or pyelonephritis is suspected by history, physical and urinalysis, a urine culture
should be sent. A catheterized specimen should be obtained for a culture in all
