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Cerebral Edema and Diabetic Ketoacidosis: Rebaked

Pediatric EM Morsels

Cerebral edema is the most feared emergent complication of pediatric diabetic ketoacidosis. The exact mechanism is not known… It was previously believed that it was due to rapid changes in serum osmolality during initial fluid resuscitation. Pediatr Diabetes. The mortality rate for cerebral edema is 21%–24%.

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But Can You Just PO?

Taming the SRU

Fluid management in the Emergency Department (ED) is crucial in the adequate resuscitation of the acutely ill and decompensating patient. Patients present to the ED with hypovolemia secondary to a plethora of causessome requiring IV fluid resuscitation and others requiring none.

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ToxCard: Iron

EMDocs

6 Can see subsequent electrolyte disturbances and dehydration related to severity of GI symptoms. Ferrous sulfate tablets are radiopaque and can be visualized on radiographs, however not all preparations are radiopaque (pediatric chewable and liquid preparations). Arch Pediatr Adolesc Med. 1 Obtain a single view abdominal x-ray.

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emDOCs Podcast – Episode 100: Acute Chest Syndrome Part 1

EMDocs

Other causes of sickling: acidosis, dehydration, inflammation, infection, fever, and blood stasis Sickling leads to vascular occlusion, end-organ ischemia, and decreased RBC lifespan, which, in turn, leads to pain crisis, acute anemia, sequestration, infection, and acute chest syndrome (ACS.) times maintenance.

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emDOCs Podcast – Episode 101: Acute Chest Syndrome Part 2

EMDocs

Other causes of sickling: acidosis, dehydration, inflammation, infection, fever, and blood stasis. Fluid management Goal is euvolemia Dehydration – needs IV fluid resuscitation. If euvolemic – start maintenance fluids of D5 in 0.45%NS Decreases splinting and improves tidal volumes.

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Haemolytic Uraemic Syndrome

Don't Forget the Bubbles

She appears pale and dehydrated , and her level of alertness fluctuates. She receives fluid resuscitation, and you organise some tests to find out why she is so tired. Pay specific attention to fluid status, looking for evidence of dehydration. Pediatric Nephrology. 2015 Jul 4;30(12):2115–9.

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emDOCs Revamp – Acute Chest Syndrome

EMDocs

Pediatr Allergy Immunol Pulmonol. Pediatr Blood Cancer. smoke, high ozone levels, smog) Asthma/reactive airway disease (RAD) Diagnostic criteria 7,8 Respiratory symptoms +/- fever (at least 38.0 C or 100.4 2 mcg/kg, max 100 mcg) while obtaining IV access 20 IV/IM ketorolac (1 mg/kg, max 15 mg) Morphine (05-0.1 mg/kg, max 0.4