Metabolic emergencies (peds): Difference between revisions

Latest revision as of 15:59, 22 March 2016

Background

References

Authors:

@@ Line 1: / Line 1: @@
-== Hypoglycemia ==
+==Background==
-=== Diagnosis ===
+*[[Adrenal Insufficiency]]
-*Glucose <45 in symptomatic neonate
+*[[Hypoglycemia (peds)]]
-*Glucose <35 in asymptomatic neonate
+*[[Inborn errors of metabolism]]
-*Most common features: vomiting, AMS, poor feeding
-**May also see lethargy, apnea, sz
-===Etiology===
+==References==
+<References/>
-#Inadequate oral intake
+[[Category:Endocrinology]]
-#Excess insulin
+[[Category:Pediatrics]]
-##Newborns of diabetic mothers
-#Deficient hyperglycemic hormones (GH or adrenal hormone deficiency)
-#Fatty acid oxidation or carbohydrate metabolism disorders
-#Prematurity (inadequate glycogen stores)
-#Sepsis
-===Work-Up===
-*Rapid glucose
-*UA
-**If ketones: adrenal or GH deficiency, inborn errors of metabolism
-**If no ketones: Hyperinsulinemia, fatty acid oxidation defects
-*Glucagon 0.3 mg/kg IM or IV
-**If BS corrects then likely due to hormonal deficiency (e.g. adrenal insufficiency)
-=== Treatment  ===
-{| cellspacing="1" cellpadding="3" border="0" bgcolor="#666666" style="width: 645px; height: 357px;"
-|- class="font12" style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;"
-! bgcolor="#ffffff" align="left" valign="top" rowspan="1" | Patient Age
-! bgcolor="#ffffff" align="left" valign="top" rowspan="1" | Dextrose Bolus Dose
-! bgcolor="#ffffff" align="left" valign="top" rowspan="1" | Dextrose Maintenance Dosage
-! bgcolor="#ffffff" align="left" valign="top" rowspan="1" | Other Treatments to Consider
-|- class="font12" style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;"
-| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="2" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" | Neonate
-| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="2" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" | D10 5 mL/kg PO/NG/IV/IO
-| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="2" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" | 6 mL/kg/h D10
-| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" | Glucagon, 0.3 milligram/kg IM
-|- class="font12" style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;"
-| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" | Hydrocortisone, 25 grams PO/IM/IV/IO
-|- class="font12" style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;"
-| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="4" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" | Infant
-| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" | D10 5 mL/kg PO/NG/IV/IO
-| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="4" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" | 6 mL/kg/h D10
-| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" | Glucagon, 0.3 milligram/kg IM
-|- class="font12" style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;"
-| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" | ''or''&nbsp;
-| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="3" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" | Hydrocortisone, 25 grams PO/IM/IV/IO
-|- class="font12" style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;"
-| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" | D25 2 mL/kg
-|- class="font12" style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;"
-| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" | &nbsp;
-|- class="font12" style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;"
-| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="2" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" | Child
-| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="2" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" | D25 2 mL/kg PO/NG/IV/IO
-| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="2" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" |
-mL/kg/h D10 for the first 10 kg
-+ 3 mL/kg/h for 11–20 kg
-+ 1.5 mL/kg/h for each additional kg &gt;20 kg
-| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" | Glucagon, 0.3 milligram/kg/IM
-|- class="font12" style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;"
-| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" | Hydrocortisone, 50 grams PO/IM/IV/IO
-|- class="font12" style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;"
-| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="2" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" | Adolescent
-| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="2" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" | —
-| bgcolor="#ffffff" align="left" valign="top" class="font12" rowspan="2" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" |
-mL/kg/h D10 for the first 10 kg
-+ 3 mL/kg/h for 11–20 kg
-+ 1.5 mL/kg/h for each additional kg &gt;20 kg
-| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" | Glucagon, 0.3 milligram/kg IM
-|- class="font12" style="font-size: 12px; line-height: 17px; margin: 0px 0px 9px;"
-| bgcolor="#ffffff" align="left" valign="top" class="font12" style="color: rgb(51, 51, 51); font-size: 12px; line-height: 17px; margin: 0px 0px 9px;" | Hydrocortisone, 100 grams PO/IM/IV/IO
-|}
-==Inborn Errors of Metabolism==
-===Background===
-*Clinical manifestations are due to accumulation of toxic metabolites
-*Must rule-out sepsis (more common in these pts)
-===Diagnosis===
-*Encephalopathy
-*Hypoglycemia
-*Hepatic dysfunction
-*Nonspecific complaints: lethargy, irritability, N/V
-===Work-Up===
-*Glucose level
-*UA (ketones)
-*Chemistry
-**Anion gap a/w organic acidemias
-*LFT
-*Ammonia
-**Should be <200 in normal neonate (higher suggests urea cycle disorders)
-*Lactate
-*VBG
-===Treatment===
-#NS 20 mL/kg boluses
-##Increase renal excretion of toxic metabolites
-#Keep NPO
-##Removes potential inciting metabolic substrates
-##Provide D10 at 2x usual maintenance rates
-#Hyperammonemia
-##<500
-###(Na phenylacetate & Na benzoate) 250mg/kg in D10 over 90min; then 250 mg/kg/d infusion
-###Arginine 210mg/kg IV/IO in D10 over 90min; then 210 mg/kg/d infusion
-##>600
-###Dialysis
-#Cerebral edema
-##Hyperammonemia is risk factor
-###Give mannitol 0.5gm/kg IV/IO
-###Do not give steroids (worsens hyperammonemia)
-== Source ==
-Tintinalli
-[[Category:Peds]]