Pediatric emergency medicine trisk 1393 1393
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Distension/pain (necrotizing enterocolitis, mass, obstruction, perforation,
laceration, hematoma, contusion, appendicitis, infection, inflammation,
ascites)
Metabolic/endocrine
Acidosis (exercise, fever, hypothermia, dehydration, sepsis, shock, IEM, liver
disease, renal disease, diabetic ketoacidosis, salicylates)
Hyperammonemia (IEM, liver failure)
Serum chemistry disturbance (hyperkalemia/hypokalemia,
hypercalcemia/hypocalcemia, hypophosphatemia,
hypermagnesemia/hypomagnesemia)
Respiratory chain disturbance (cyanide, mitochondrial disorders)
Endocrine (hyperglycemia/hypoglycemia, hyperthyroidism/hypothyroidism,
hyperparathyroidism, adrenal hyperplasia)
Hematologic
Anemia, abnormal hemoglobin (inadequate erythrocyte numbers, decreased
production, loss, hemoglobinopathy, methemoglobin, carboxyhemoglobin)
Polycythemia
IEM, inborn error of metabolism.
Common causes of lower airway obstruction involve inflammation and
bronchospasm and include asthma, allergy/anaphylaxis, and bronchiolitis.
Wheeze, most often diffuse, is usually a predominant feature of these conditions
(see Chapter 84 Wheezing ). Asthma may be triggered by infection, exercise,
environmental irritants, stress, and/or gastroesophageal reflux. Allergy, usually
accompanied by coryza, congestion, mucosal edema, and/or rash, may be in
response to environmental exposures, food, or medications. Bronchiolitis may be
caused by respiratory syncytial virus as well as parainfluenza, influenza,
adenovirus, metapneumovirus, or other viruses. It is the most common cause of
lower respiratory illness in children younger than 2 years. These conditions cause
airway obstruction by decreasing airway luminal area secondary to
bronchospasm, edema, or thickening of the wall of the lumen. Lower airway
obstruction is also caused by filling of the airway lumen by excessive secretions
(e.g., from inflammation, infection, or toxin such as organophosphate) or
aspirated fluids. External compression can also lead to a decrease in lumen size of
lower airways (e.g., with emphysema and masses).
