Share the postWhat follows is a chart on how to follow asymptomatic newborns at risk of hypoglycemia from the AAP.
Several features make sorting through the differential diagnosis challenging to the emergency physician.
Diabetic Ketoacidosis (DKA) is a life-threatening emergency condition that often occurs in patients with type I Diabetes. The early stages of cancer may be asymptomatic, but a malignant tumor will eventually grow–large enough to be detected. Other symptoms include persistent headaches, chronic pain in bones and various areas of the body, persistent fatigue, persistent low-grade fever and repeated infection. Nurses are encouraged to provide as much care and comfort as possible to patients with cancer. Priorities of care include provision of information about the disease, prevention of complications, promotion of comfort and preservation of optimal physiological functioning.
It occurs when the sugar (glucose) in your body is not enough to be used as fuel for cells.
The more it grows, the more it presses on nerves, producing pain and interfering with bodily functions. Interventions (CANCER) should be focused on patient’s comfort, altered body image, nutrition, chemotherapy, response to medications and respite for caretakers.
It is produced by the pancreas in response to increased glucose levels in the blood. Hypoglycemia is relatively common in persons with diabetes. Many times, the exact etiology will not be determined in the ED, and a generalized approach is appropriate. 5 Nursing Jobs At Home You Can Consider 6 Easy Passive Income Ideas for Busy Nurses Today's Meme: Brace Yourselves 7 Easy Stain Removal Tips Every Nurse Needs To Know 5 Things You Should Know Before Becoming a Vocational Nurse Today's Meme: Am I Going Crazy? Babies born to mothers with diabetes may have severe hypoglycemia. Idiopathic hypoglycemia is hypoglycemia that occurs without a known cause. A recent study suggests that purulent tracheal exudates are more likely in somewhat older, less-sick school-age children who may not require intubation.34 Bacterial infection of the trachea can lead to profound respiratory distress, with upper airway stridor, high fever, and a productive cough.


Croup, usually due to parainfluenza virus, is characteristically a relatively mild outpatient disease, but it occasionally may present with severe respiratory distress or failure. This can cause high blood sugar and weight gain. Persons with severe hypoglycemia are treated with glucose injections or the hormone glucagon.
These children tend to have copious rhinorrhea in association with an antecedent upper respiratory tract infection. Immediate treatment is needed to prevent serious complications or death. Preventing low blood sugar is better than having to treat it. Critically illinfants with bronchiolitis can become dehydrated from insensible losses and decreased fluid intake. Make sure you have snacks with you if you take insulin or other medicines that lower your blood sugar. Ask your doctor or nurse if you need a bedtime snack to prevent low blood sugar overnight. If you do drink, have only one or two drinks at the most. Your doctor may tell you to change your diet so that you get more even amounts of glucose into your body throughout the day.
Severe hypoglycemia is a medical emergency that may result in seizures and permanent damage to the nervous system if not treated. In one review involving 580,000 pediatric ED visits, there were only 320 cases of cardiac arrhythmias, half of which were sinus tachycardia and 13% of which were supraventricular tachycardia.11 Supraventricular tachycardia is an important cause of cardiogenic shock in infants.
With reentrant tachycardia, an infant?s heart rate may reach as high as 300 beats per minute.
At that rate, there is little time for the heart to fill during diastole.MyocarditisMyocarditis is the most common acquired cause of cardiomyopathy and heart failure in children and is usually due to a viral infection of the heart.
A murmur may or may not be appreciated.Genitourinary CausesInfants can develop renal failure and altered mental status if they have congenital genitourinary abnormalities.
One retrospective chart review examined 120 patients 5 years of age or younger who required an operation for appendicitis.42 All 10 of the children under the age of 1 year had perforated their appendix at the time of surgery.
Although well-described in the literature, it is not clear why intussusception causes altered mental status.44-46 While the supposedly classic ?currant jelly? stool is seen in a small minority of cases,47 heme-positive stools are common.
The largest study on midgut volvulus showed that over half of the patients presented during the first 30 days of life.6 Bilious vomiting was seen in all of the patients with midgut volvulus.


Under physiologic stress, such as infection or dehydration, cortisol deficiency leads to hypoglycemia.51 Acute saltwasting crisis typically presents in infants 2-5 weeks of age. The initial symptoms are nonspecific, such as poor feeding, vomiting, inadequate weight gain, and irritability. Idiopathic ketotic hypoglycemia is typically associated with fasting due to vomiting and diarrhea in previously healthy toddlers and preschoolers. Young children who accidentally ingest (or are intentionally given) alcohol will also develop low blood sugars. It is crucial to remember that hypoglycemia is common in critical illnesses from a variety of causes. In one study, nine of 49 children (18%) requiring resuscitation in the ED had associated hypoglycemia.53Diabetic KetoacidosisDiabetic ketoacidosis can produce shock from both fluid losses and electrolyte abnormalities. One study reviewed all deaths in the United Kingdom for individuals under 20 years of age who had diabetes listed on the death certificate. Of 116 deaths, 69 were attributable to diabetic ketoacidosis and seven to hypoglycemia.54Neurologic CausesNeurologic causes of the acutely ill appearance or comatose state include acute hydrocephalus, central nervous system tumor, ventriculoperitoneal (VP) shunt malfunction or infection, rupture of an arteriovenous malformation, and nonconvulsive status epilepticus.
Vomiting, depressed mental status, and a focal neurologic examination are common in these conditions.Nonconvulsive status epilepticus can produce coma or altered mental status. It can be difficult to diagnose, as the child has no abnormal motor activity; the diagnosis can be confirmed only on electroencephalogram. The prevalence of nonconvulsive status epilepticus in children remains unknown.55,56Traumatic CausesNon-accidental trauma may present in a variety of ways, many of which are subtle. Bruising, a suspicious story, a bulging fontanelle, and retinal hemorrhages are characteristic.Toxicologic CausesThe evidence regarding toxicologic causes primarily consists of case reports and case series. After the child begins to crawl at 6 or 7 months, accidental ingestions become more common.



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Comments

  1. 05.11.2014 at 15:21:36


    Myocardial ischemia in asymptomatic diabetic subjects than fifteen.

    Author: KOMENTATOR
  2. 05.11.2014 at 14:31:36


    Levels further and lead to hyperglycaemia (high blood another symptom that occurs.

    Author: Nastinka
  3. 05.11.2014 at 14:26:55


    Have had gestational diabetes (occurs in 2-10% of pregnancies) have sugar.

    Author: E_e_E