0071643192.pdf

PEDIATRICS

DIAGNOSIS

■ Culture of organism from sterile body fluid (blood, CSF)

■ Gram stain demonstrating Gram-negative diplococci supports the pre-

sumptive diagnosis of infection.

■ DIC may be present.

TREATMENT

■ Antibiotics (penicillins or cephalosporins): Give early!

■ Chemoprophylaxis for close contacts (rifampin or ceftriaxone for children;

ciprofloxacin for adults)

■ Report diagnosis to local health department.

COMPLICATIONS

■ Fatality rate 10% for all ages (fatality rate up to 25% in adolescents): Give

early!

■ Bilateral sensorineural deafness is the most common complication from

meningitis caused by N. meningitidis.

■ Myocarditis

■ Pericarditis

■ Pneumonia

ENDOCRINE AND METABOLIC DISORDERS

A 3-week-old male infant presents to the ED with a history of poor feed-

ing, poor weight gain since birth, lethargy, irritability, and occasional vomit-

ing. Laboratory evaluation shows an Na of 128, a K of 7, and glucose of 52.

What is the likely diagnosis?

Congenital adrenal hyperplasia.

Congenital Adrenal Hyperplasia

The ED physician may be the first to diagnose this condition. Urgent recogni-

tion of the condition can be life saving.

SYMPTOMS/EXAM

■ When the defect primarily involves the adrenal system, children present

with more gradual onset of malaise, anorexia, and weight loss.

■ Ambiguous genitalia

■ Acute salt-wasting crisis

■ Precocious virilizationin older children

DIAGNOSIS

■ Electrolytes and blood glucose testing reveal hyponatremia, hyperkalemia,

and hypoglycemia

■ ACTH stimulation testing confirms the diagnosis of adrenal insufficiency.

■ Specific enzyme testing should reveal the specific enzymatic deficiency.

Females will usually present

with ambiguous genitalia due

to virilization; males have

normal genital development

and usually present with salt

wasting during infancy and

precocious puberty during

childhood.