Evidence-Based Management Of Metabolic Emergencies In The Pediatric Emergency Department

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This issue includes 4 AMA PRA Category 1 Credits^TM; 4 ACEP category 1 credits; and 4 AAP Prescribed credits.

Authors

Philip H. Ewing, MD
Assistant Professor, Division of Pediatric Emergency Medicine,
University of Texas, Southwestern Medical Center at Dallas, Dallas, TX

Robert A. Wiebe, MD
Professor, Division of Pediatric Emergency Medicine, University of
Texas, Southwestern Medical Center at Dallas, Dallas, TX

Peer Reviewers

John C. Brancato, MD
Assistant Professor of Pediatrics and Emergency Medicine;
Director, Fellowship in Pediatric Emergency Medicine, University
of Connecticut School of Medicine; Children’s Medical Center, Hartford, CT

Ghazala Sharieff, MD, FAAP, FACEP, FAAEM
Associate Clinical Professor, Children’s Hospital and Health
Center/ University of California, San Diego; Director of Pediatric
Emergency Medicine, California Emergency Physicians, San Diego, CA

Publication Date: October 2009; Volume 6, Number 10

Excerpt from the issue...

A previously healthy 18-month-old girl presented to the emergency department with a 1-day history of poor feeding. On the morning of presentation, she was unarousable, so her parents called EMS. Paramedics arrived to find a somnolent child who was warm and well perfused, with a blood glucose level that was undetectable on a portable glucometer. She was given an infusion of glucose and transported to the ED, where she became somewhat more interactive. Blood and urine samples showed a normal blood sugar level and no ketonuria. The patient was continued on intravenous (IV) fluids containing dextrose and admitted to the hospital for observation. Her clinical course was unremarkable until that night, when she was weaned from IV fluids. At 4 am, her blood glucose level measured 47 mg/dL, and she was unarousable. As glucose was given, a more extensive laboratory panel was drawn, and her urine was collected a second time. The patient’s diagnosis was made on the basis of these samples.

This issue of Pediatric Emergency Medicine Practice examines approaches to the pediatric patient who presents to the ED with a metabolic emergency and identifies areas where diagnostic and therapeutic strategies fall short from an evidence-based perspective.