Pediatric emergency medicine trisk 1537 1537
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children unable to provide a clean-catch specimen. A pregnancy test should be
obtained in all menstruating females presenting with a urinary complaint, and
sexually transmitted infection (STI) testing (including urine gonococcal and
chlamydial testing) is warranted for sexually active adolescents. Additional
urinary studies, such as urine chemistries, may be indicated if renal parenchymal
or tubular diseases, such as Fanconi syndrome, are suspected. Serum testing
should be undertaken if the diagnosis is not readily apparent or if indicated by the
potential diagnosis implied by the urinalysis. If there is concern for renal
parenchymal disease, then electrolytes, blood urea nitrogen, creatinine, and
calcium should be obtained. Serum electrolytes should be evaluated when
concern exists for either central or nephrogenic DI, and a venous blood gas, in
addition to a hemoglobin A1C, should be collected when concern for DM exists.
Inflammatory markers can be helpful if appendicitis is suspected.
FIGURE 78.1 Interpretation of urinalysis.
Imaging studies obtained emergently should be guided by the differential
diagnosis. A renal and bladder ultrasound is useful in assessing for
nephrolithiasis, and is indicated nonemergently for UTIs that occur in infants.
Ultrasounds of the appendix and pelvis are warranted if appendicitis or ovarian
torsion, respectively, are being considered. An abdominal radiograph to assess
stool burden can be obtained if constipation is suspected as the etiology of urinary
frequency. If a neurogenic bladder (related to a spinal cord lesion such as a
tethered cord) or a space-occupying lesion (leading to central DI) is suspected,
emergent neuroimaging, either via CT scan or MRI, is warranted. A specialty
consultation by a nephrologist is indicated if underlying renal parenchymal
