Clinical Pediatric Emergency Medicine RSS feed: Current Issue. This practical journal is devoted to helping pediatricians and emergency physicians provide the best possible care for their young patients. Each topical issue focuses on a single condition frequently seen. Cogently written review articles synthesize practical new advances in the field giving you the authoritative guidance on disease process, diagnosis, and management you need to achieve the best results.http://www.clinpedemergencymed.com/?rss=yesElsevier Inc.en © 2009 Published by Elsevier Inc. All rights reserved. Clinical Pediatric Emergency Medicine1522-8401104December 2009 © 2009 Published by Elsevier Inc. All rights reserved. healthpermissions@elsevier.comhttp://www.clinpedemergencymed.com/article/PIIS1522840109000998/abstract?rss=yesTable of Contents10.1016/S1522-8401(09)00099-8Clinical Pediatric Emergency Medicine 10, 4 (2009)2009-12-01Clinical Pediatric Emergency Medicine2009-12-01104S1522-8401(09)X0005-4iihttp://www.clinpedemergencymed.com/article/PIIS1522840109001001/abstract?rss=yesEditorial Board10.1016/S1522-8401(09)00100-1Clinical Pediatric Emergency Medicine 10, 4 (2009)2009-12-01Clinical Pediatric Emergency Medicine2009-12-01104S1522-8401(09)X0005-4iiiihttp://www.clinpedemergencymed.com/article/PIIS1522840109000962/abstract?rss=yesThis issue of Clinical Pediatric Emergency Medicine features endocrine disorders with which pediatric patients present to the emergency department. Dr Fogel discusses diagnosis and treatment of ketoacidosis. She points out that the diagnosis depends on the presence of hyperglycemia (typically glucose >200 mg/dL) in association with HCO3 levels of 15 mEq/L or lower and venous pH of 7.3 or less. Currently, the clinical practice is to limit the total volume of fluids administered to patients with ketoacidosis to 3500/mL/m2/day. Finally, the most frequent method of insulin administration is by continuous infusion, starting with 0.1/kg/hr.Pediatric Endocrine EmergenciesDonald Zimmerman10.1016/j.cpem.2009.11.003Clinical Pediatric Emergency Medicine 10, 4 (2009)2009-12-01Clinical Pediatric Emergency Medicine2009-12-01104S1522-8401(09)X0005-4Guest Editor's Preface245245http://www.clinpedemergencymed.com/article/PIIS1522840109000871/abstract?rss=yesDiabetic ketoacidosis results from deficient insulin action and increased action of hormones such as catecholamines, glucagon, glucocorticoids, and growth hormone, which are produced during stress and which antagonize insulin's actions. Diabetic ketoacidosis is associated with a relatively high mortality rate. Treatment consists of appropriate fluid resuscitation, insulin infusion, adjustments of electrolytes and phosphate, and careful monitoring. The most common serious complication is cerebral edema.Management of Diabetic Ketoacidosis in the Emergency DepartmentNaomi Fogel, Donald Zimmerman10.1016/j.cpem.2009.10.002Clinical Pediatric Emergency Medicine 10, 4 (2009)2009-12-01Clinical Pediatric Emergency Medicine2009-12-01104S1522-8401(09)X0005-4246251http://www.clinpedemergencymed.com/article/PIIS1522840109000949/abstract?rss=yesIntercurrent illness may trigger hyperglycemia as a result of the secretion of stress hormones and cytokines. This condition is termed “stress hyperglycemia.” Patients with stress hyperglycemia (rather than diabetes mellitus) usually do not have a lengthy history of polyuria, polydipsia, or weight loss. They do not manifest symptoms or signs of ketoacidosis (hyperpnea, acetone smell of breath). In addition, biochemical evidence of ketoacidosis is absent. If hyperglycemia is associated with a serum glucose above the low 200s, inpatient evaluation is preferred. In the emergency department, hemoglobin A1c can help acutely in estimating chronicity, with high levels prompting admission. Levels of diabetes antibodies should be drawn, and follow-up should be arranged to ascertain normalcy of glucose after resolution of the intercurrent illness.Hyperglycemia Not Due to Diabetes MellitusCourtney Finlayson, Donald Zimmerman10.1016/j.cpem.2009.11.001Clinical Pediatric Emergency Medicine 10, 4 (2009)2009-12-01Clinical Pediatric Emergency Medicine2009-12-01104S1522-8401(09)X0005-4252255http://www.clinpedemergencymed.com/article/PIIS1522840109000895/abstract?rss=yesTraumatic brain injury (TBI) is a major cause of morbidity and mortality in children. Subsequent endocrine changes have been illustrated in adults and have been recently investigated in children as well. Head injury occurs often in children, and TBI has accounted for many emergency department visits. The most common type of brain injury in children is diffuse brain injury caused by acceleration or deceleration forces. In adults, there is no relationship that has emerged between the occurrence of pituitary dysfunction and time after TBI, type or severity of initial injury, or later outcome. In pediatrics, studies have shown that a delay in diagnosing pituitary dysfunction was common. In children with TBI, a screening algorithm, starting with measurement of an early-morning cortisol, should be followed to identify pituitary dysfunction in a timely fashion and initiate treatment promptly when necessary.Anterior Pituitary Dysfunction and Traumatic Brain InjuryShivani P. Shah, Donald Zimmerman10.1016/j.cpem.2009.10.004Clinical Pediatric Emergency Medicine 10, 4 (2009)2009-12-01Clinical Pediatric Emergency Medicine2009-12-01104S1522-8401(09)X0005-4256259http://www.clinpedemergencymed.com/article/PIIS152284010900086X/abstract?rss=yesAdrenal insufficiency is an important and potentially life-threatening condition that may present to the emergency department. Seven clinical scenarios of adrenal insufficiency that the emergency physician should be able to recognize and confidently manage are reviewed. Epidemiology and mortality, etiology, and pathophysiology are addressed. Clinical presentation, diagnosis, and management of acute and chronic adrenal disease are also covered. In particular, adrenal suppression due to exogenous steroid use, adrenal suppression in septic shock, and adrenal suppression associated with etomidate are reviewed.Adrenal Insufficiency in the Pediatric Emergency DepartmentRachel Tuuri, Donald Zimmerman10.1016/j.cpem.2009.10.001Clinical Pediatric Emergency Medicine 10, 4 (2009)2009-12-01Clinical Pediatric Emergency Medicine2009-12-01104S1522-8401(09)X0005-4260271http://www.clinpedemergencymed.com/article/PIIS1522840109000950/abstract?rss=yesDysnatremias can be a challenging diagnosis for pediatric emergency care providers because patients can present with vague symptoms but can quickly develop neurologic sequelae. It is important that emergency care physicians are knowledgeable about higher risk populations, clinical presentation, and possible etiologies to provide prompt treatment. This article will present 2 cases with sodium abnormalities and then review the epidemiology, pathophysiology, and current management practices for dysnatremias.Hypernatremia and Hyponatremia: Current Understanding and ManagementCatherine H. Chung, Donald Zimmerman10.1016/j.cpem.2009.11.002Clinical Pediatric Emergency Medicine 10, 4 (2009)2009-12-01Clinical Pediatric Emergency Medicine2009-12-01104S1522-8401(09)X0005-4272278http://www.clinpedemergencymed.com/article/PIIS1522840109000883/abstract?rss=yesHyperthyroidism may present to physicians in the emergency department in a variety of ways. Using a case-based approach, this article provides a review of 3 such presentations, Graves disease, thyroid storm, and the accidental ingestion of thyroid hormone. Each case will offer a review of the evaluation and management of children with disorders of hyperthyroidism and specific recommendations pertaining to each case.Hyperthyroidism in the Emergency DepartmentCourtney Finlayson, Donald Zimmerman10.1016/j.cpem.2009.10.003Clinical Pediatric Emergency Medicine 10, 4 (2009)2009-12-01Clinical Pediatric Emergency Medicine2009-12-01104S1522-8401(09)X0005-4279284http://www.clinpedemergencymed.com/article/PIIS1522840109000937/abstract?rss=yesInfants and children presenting to the emergency department with hypoglycemia are a diagnostic emergency and require urgent treatment. The metabolic adaptive patterns of fasting occur earlier in children compared to adults, most notably with the development of ketone bodies. Glucose is the preferred energy source for the brain; however, when deprived of glucose, ketone bodies are an alternative fuel that may cross the blood-brain barrier. As infants and children have a relatively larger brain to body size and their rates of glucose use are higher, they are at increased risk of hypoglycemia. Collection of the "critical sample" to assist in the diagnostic work-up and urgent treatment to stabilize blood glucose levels is of paramount importance to protect the developing brain from glucose deprivation.Hypoglycemia in the Emergency DepartmentJami Josefson, Donald Zimmerman10.1016/j.cpem.2009.10.008Clinical Pediatric Emergency Medicine 10, 4 (2009)2009-12-01Clinical Pediatric Emergency Medicine2009-12-01104S1522-8401(09)X0005-4285291http://www.clinpedemergencymed.com/article/PIIS1522840109000913/abstract?rss=yesAn 11-week-old baby boy was sent to the emergency department by his pediatrician for failure to thrive and 3 days of weak cry. He had only gained 3 oz since his 2-month-old well-child checkup, despite feeds of 3 to 4 oz of Enfamil Lipil with iron every 4 hours. He had 6 to 8 wet diapers each day, without any recent changes, and he had nonbloody yellow bowel movements once every 3 days, for which his pediatrician has prescribed daily corn syrup. He had an occasional nonbilious, nonbloody emesis about every 3 to 4 days. In the office, the pediatrician had obtained a finger stick glucose, which was normal at 85 mg/dL.The Floppy Little BabySabah F. Iqbal, Dewesh Agrawal10.1016/j.cpem.2009.10.006Clinical Pediatric Emergency Medicine 10, 4 (2009)2009-12-01Clinical Pediatric Emergency Medicine2009-12-01104S1522-8401(09)X0005-4Emergi-Quiz Cases292297http://www.clinpedemergencymed.com/article/PIIS1522840109000901/abstract?rss=yesThe patient is a 12-month-old male infant with global developmental delay who presented to the emergency department with a history of refusal to eat. On presentation, his mother reported that for the 4 days before presentation, he had refused to take formula, been increasingly irritable, and developed abdominal distension. He has had several episodes of “spitting up,” which was slightly increased from his baseline. The mother noted 3 to 4 large, green, soft stools without blood or mucous and decreased urine output on the day of this visit. She denied the presence of fever but stated that he had been coughing and intermittently breathing “hard and fast.” Three months before this current episode, he had similar symptoms requiring hospital admission and treatment for dehydration.Food Aversion and Irritability in an InfantKatherine Nicholson, Lei Chen10.1016/j.cpem.2009.10.005Clinical Pediatric Emergency Medicine 10, 4 (2009)2009-12-01Clinical Pediatric Emergency Medicine2009-12-01104S1522-8401(09)X0005-4Emergi-Quiz Cases298302http://www.clinpedemergencymed.com/article/PIIS1522840109000925/abstract?rss=yesA 5-year-old white boy was sent to the emergency department by his pediatrician for fever and abdominal distention. For 1 month, his parents had noted intermittent fevers, with daily fevers (maximum temperature, 38.5°C) for 1 week. He had an enlarging “bump” over the right upper quadrant of his abdomen for 2 weeks and vague intermittent abdominal pain for 2 days. There was no history of vomiting, and stools had been normal (1-2 per day, loose, malodorous, no blood). His parents reported decreased energy for the last month but a normal appetite. No recent weight loss, bone or joint pain, or rashes were noted. Review of systems was positive for seasonal allergies and 1 month of nonproductive cough, which was diagnosed as cough-variant asthma. The nocturnal component of the cough improved with the initiation of nebulized budesonide 4 weeks ago and a 5-day course of prednisone 2 weeks before presentation.A Child With a Massive AbdomenChristine S. Cho10.1016/j.cpem.2009.10.007Clinical Pediatric Emergency Medicine 10, 4 (2009)2009-12-01Clinical Pediatric Emergency Medicine2009-12-01104S1522-8401(09)X0005-4Emergi-Quiz Cases303308