Tag Archive for: Pediatrics

Pediatric DKA: Do Fluids Really Matter?

11 Jul
July 11, 2018

Background: The most feared complication in the clinical course of children with diabetic ketoacidosis (DKA) is the development of cerebral edema. Cerebral edema is rare (<1%) but is the leading cause of death in pediatric DKA. Many of the details about the risk factors as well as the mechanisms leading to DKA related cerebral edema are not well understood. Before we review the recent, groundbreaking study by Kupperman et al (1), examining the relationship between intravenous fluid content and rate of fluid administration in the development of DKA related cerebral edema, it’s important that we review the associated risk factors as well as the proposed mechanisms. It is important to know that the available data we are about to review comes from retrospective studies as well as case reports and case series and not from randomized control trials. Read more →

Button Battery Ingestion

04 Sep
September 4, 2017

Button Batteries: Small, disc shaped battery cells which are designed for use in small electronic devices. Common sources are kids toys, watches, calculators and hearing aids. Most batteries use lithium as a power source

Button Battery Ingestion Danger:

  • Contact with mucosal surfaces (oropharynx, esophagus, nasal passage) results in transmission of current
  • Current transmission causes chemical burns and necrosis via alkaline injury (sodium hydroxide)
  • Tissue damage can progress rapidly and result in devastating injuries
  • Nasal passage and esophagus are most susceptible to injury (narrow places for battery to become lodged)
  • Injury Patterns
    • Viscous perforation
    • Fistula formation
    • Erosion into blood vessels and resultant bleeding and possible catastrophic bleeding with erosion into aorta

Read more →

Validation of the Step-By-Step Approach to Febrile Infants

11 May
May 11, 2017

Background: Fever without source in infants less than three months old presents a difficult diagnostic dilemma for ED physicians.  Over the past 25 years several algorithms have been developed to help guide clinicians, most notably the Rochester, Philadelphia and Boston Criteria, in determining which infants require admission vs. outpatient management.  These studies were designed published between 1992 and 1994 prior to the wide spread use of HiB and pneumococcal vaccines in children, maternal GBS screening and the development of many new biomarkers. 

The Step-by-Step approach to febrile infants was developed by a European group of pediatric emergency physicians with the objective of identifying low risk infants who could be safely managed as outpatients without lumbar puncture or empiric antibiotic treatment. The algorithm was designed using retrospective data and this study attempts to prospectively validate it. Read more →

Pediatric Septic Hip

06 Mar
March 6, 2017

Pediatric Septic Hip Definition: Bacterial infection of the hip joint space and synovial fluid

Background:

  • Causes
    • Hematogenous spread in bacteremia
    • Local spread (i.e. from osteomyelitis)
    • Direct inoculation (traumatic or surgical)
  • High-Risk Subgroups
    • Age < 2 years (peak incidence 6 – 24 months)
    • Immunocompromised state (i.e. AIDS, active cancer, etc)
    • Functional asplenia (i.e. sickle cell disease)
  • Complications
    • Sepsis
    • Osteomyelitis
    • Chronic arthritis
    • Osteonecrosis
    • Capsule damage

Read more →

Forget the PediaLyte and Just use Dilute Apple Juice in Mild Gastroenteritis

02 Jun
June 2, 2016

Dilute Apple JuiceBACKGROUND: Every year in the United States there are an estimated 178.8 million episodes of acute gastroenteritis resulting in 473,832 hospitalizations.  Most of the evidence surrounding oral rehydration centers around Oral Rehydration Therapy (ORT) studies in low-income countries where children suffer from more extensive gastrointestinal losses.  Theoretically, electrolyte maintenance solutions are recommended in order to prevent increasing diarrheal losses through the osmotic diuresis that can occur with glucose-rich drinks like juice.  However, these electrolyte maintenance solutions can cost up to $10 for a 1-liter bottle and are unpalatable to some children.  Refusal to drink often results in the need for IV hydration and can potentially result in disease progression and hospitalization.  This study attempted to look at whether a dilute apple juice solution or preferred fluids was equal to, if not superior to oral hydration with an electrolyte maintenance solution. Read more →

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