0071643192.pdf

(Barré) #1

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.
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