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An Evidence-Based Review Of Dehydration In The Pediatric Patient - $30.00
This issue includes 4 AMA PRA Category 1 CreditsTM; 4 ACEP category 1 credits; and 4 AAP Prescribed credits.
Authors
Alan L. Nager, MD Director, Division of Emergency And Transport Medicine, Department Of Pediatrics, University Of Southern California And The Keck School Of Medicine, Los Angeles, CA
Peer Reviewers
George R. Hutchison, MD, FAAEM President, Medical Emergency Trauma Associates Little Rock, AR
Paula Whiteman, MD Attending Physician, Ruth And Harry Roman Emergency Department, Cedars Sinai Medical Center, Los Angeles, CA; Director Of Pediatric Emergency Services, Providence Tarzana Medical Center, Tarzana, CA
Publication Date: January 2010; Volume 7, Number 1
Excerpt from the issue...
During a busy shift in the emergency department, you obtain a history and perform a physical examination on a 3-month-old male patient. The mother states that her son has become progressively more listless over the past 3 days, has been drinking less than normal, and has only urinated once in the previous 12 hours. She also notes that the patient has had “tremors intermittently all day.” In addition, he has had 3 episodes of vomiting without blood or bile and has a slight runny nose but no fever, diarrhea, or ill contacts.
The physical examination reveals a temperature of 37.9ºC (100.2ºF), a resting heart rate of 186 beats per minute, a respiratory rate of 56 breaths per minute, and a blood pressure reading of 78/50 mm Hg. The patient is visibly listless and has intermittent, erratic jerking in his arms and legs as well as a slightly sunken fontanel, no visible tears, and dry, sticky mucous membranes. Findings from an examination of his lungs, heart, and abdomen are normal, and further examination demonstrates slightly cool distal extremities, with a capillary refill time of 3 seconds.
This patient is clearly dehydrated, although the etiology of his signs and symptoms is unclear. As you evaluate the patient, you think about the following issues:
Historically, are there other questions that should be asked?
To what extent is the patient dehydrated (eg, mildly, moderately, severely)?
What steps should be taken regarding treatment?
Are laboratory tests required and if so, which ones?
What differential diagnoses should be considered?
This issue of Pediatric Emergency Medicine Practice discusses Dehydration In The Pediatric Patient.
Product Reviews
James Kussy, MD - 01/03/2010 This Review has brought me up to date on this pediatric patient entity. It is one which is a life-threatening one and which, to be ignorant of, could be a catastrophe for the patient and a very damaging career event for the practitioner with the very stressful malpractice action that likely would follow. The 33 references furnished can be useful in going deeper into this problem. The Risk Management Pitfalls section is always very helpful to a practitioner of emergency medicine. Thank you. I am more than satisfied with this subscription.
