Pediatric Electrolyte Emergencies: Recognition and Management in the Emergency Department (Pharmacology CME)

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Publication Date: February 2023 (Volume 20, Number 2)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-A or 2-B Credits. CME expires 01/01/2026.

Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 1 Pharmacology credit, subject to your state and institutional approval.

Author

Peer Reviewers

Abstract

Early recognition and treatment of electrolyte abnormalities protect the patient from derangements in the renal, myocardiac, and central nervous systems. Correction of electrolyte derangements decreases both morbidity and mortality. This issue reviews sodium, potassium, calcium, magnesium, and phosphorus abnormalities and provides a systematic approach to the evaluation and management of the ill child with an electrolyte emergency.

Case Presentations

A 3-day-old girl is brought in by her father, with concern for shaking episodes...

• The infant was born full-term and has been fed formula at home. The father has been mixing the formula himself and is unsure whether his measurements have been exact. The infant began vomiting today and is more lethargic, with intermittent jerking episodes.
• The girl's vital signs are: temperature, 37°C; heart rate, 200 beats/min; blood pressure, 60/30 mm Hg; respiratory rate, 30 breaths/min; and oxygen saturation, 100% on room air. The child has a sunken anterior fontanelle.
• What workup should you initiate at this time?

A 5-year-old girl is brought into the emergency fast track for concern for abnormal urination...

• The girl’s mother says at first, she believed it was bedwetting; however, it has been worsening in frequency. She reports the girl has been drinking excessive amounts of water and now has been having voluminous clear urine for the last 2 days. The girl has been sleepy all day and is now no longer interacting or speaking.
• On examination, the girl has dry mucous membranes, is tachycardic, and has a capillary refill time of 3 seconds.
• What conditions should be on the differential? Are there any immediate interventions that should be pursued?

A high school football player presents fatigued and with diffuse pain…

• The boy has just finished his second practice of the day.
• His heart rhythm appears abnormal on telemetry, and he is sweating profusely.
• What could be causing the observed dysrhythmia in this patient?

A 2-year-old with vomiting and diarrhea is brought in by her parents…

• The girl’s parents report they have had similar symptoms as well, having just arrived from overseas.
• On examination, the child appears listless, with tachycardia and sunken eyes, arousable only to vigorous stimulation. There is nonbloody vomitus on the bed and nonbloody diarrhea in the child’s diaper.
• What immediate concerns need to be addressed for this patient? How might you approach the differential diagnosis?

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.