Endocrine emergencies: integrated approach

This page links the emergencies that a paediatric registrar meets in the resuscitation bay: DKA, adrenal crisis, thyroid storm, severe hypoglycaemia and the vasopressin disorders. Each has its own leaf. Here the focus is on the first tests and first treatments that the cited guidance gives for each one. ^{[1] [2] [4] [9] [16]}

Overview & Definition

A child with rapid breathing, or with vomiting and abdominal pain without diarrhoea, may be in DKA. ISPAD notes that the symptoms of DKA are non-specific. It therefore advises considering a fingerstick blood glucose in all such children. ^[1]

ISPAD defines DKA with three biochemical criteria. All three are required: blood glucose above 11 mmol/L, venous pH below 7.3 or serum bicarbonate below 18 mmol/L, and ketonaemia or ketonuria. A blood beta-hydroxybutyrate of 3 mmol/L or more is a sensitive indicator of DKA. ^[1]

BSPED defines an adrenal crisis as a life-threatening deterioration due to glucocorticoid insufficiency. It may cause cardiovascular instability, abnormal plasma electrolytes and seizures. The features are not attributable to another illness and improve significantly after parenteral glucocorticoids. ^[2]

References17ShowHide

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13. [13]Glaser N, Barnett P, McCaslin I, et al. Risk factors for cerebral edema in children with diabetic ketoacidosis. The Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. The New England journal of medicine, 2001.PMID 11172153
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