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Food Protein Induced Enterocolitis Syndrome (FPIES)

Pediatric EM Morsels

Patients with FPIES can have marked dehydration due to vomiting and diarrhea, even to the point of hypotension! – As always, treat symptoms and dehydration based on severity. Allergy Asthma Clin Immunol 18, 54 (2022). It may sound silly (“FPIES”), but it can be serious! Volume Status?!

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Rebaked: Inborn Errors of Metabolism presenting in the ED

Pediatric EM Morsels

Dehydration Surgery Pregnancy ( If we don’t ask we don’t know ) Many important IEM are included in the Newborn Screen. Pediatr Rev (2022) 43 (7): 371–383. For milder forms of IEM, children can compensate until the body is under stress and may recover after stress (leading to delayed diagnosis). Pediatrics. 2000; 105:e 10. Samantha A.

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Cerebral Edema and Diabetic Ketoacidosis: Rebaked

Pediatric EM Morsels

Kids < 5 years of age New onset of diabetes at presentation Longer duration of symptoms Severity of acidosis Elevated BUN Greater degree of dehydration and hyperventilation Cerebral Edema and DKA: Diagnostic Considerations Early detection and treatment is the best means to prevent brain injury and death. 2022; 23( 7): 835- 856.

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Morel-Lavallée Lesion in Children

Pediatric EM Morsels

Sometimes this can be used to our advantage, like when we need to give subcutaneous fluids to a dehydrated patient without an IV, or when we need to give SQ medications for things like Sulfonylurea overdose , Hereditary Angioedema , or DVTs. 2022) Morel-lavallee lesions – diagnosis and practical management of these troublesome injuries!

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Travel-Related Illnesses in Children

Pediatric EM Morsels

In one ED study, ALL cases of missed travel-related illness did not have a documented travel history in their ED note , whereas 90% of the identified travel-related illnesses had a provider documented travel history (Greenky 2022) Those who are visiting friends and relatives (VFR) are typically at highest risk. 2022 Jun:56:113-116.

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Diabetic Ketoacidosis in Paediatrics

Mind The Bleep

Common stressors in children and adolescents include: Infections: urinary tract infections, gastroenteritis, pneumonias, Poor compliance to insulin therapy, Dehydration, Fasting state, Heatstroke Trauma. or HCO3 10-15 mmol/L: mild DKA (5% dehydration) pH < 7.2 or HCO3 5-10 mmol/L: moderate DKA (5% dehydration) pH < 7.1

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But Can You Just PO?

Taming the SRU

Other conditions that lead to intravascular fluid depletion include but are not limited to starvation/dehydration, vomiting, diarrhea, burns/trauma, hyperglycemia, and hemorrhage. Contraindications to ORT include evidence of severe dehydration which is defined as a volume loss greater than 10%. 2022 Sep 11;5(5):e827.