Evidence-Based Management Of Metabolic Emergencies In The Pediatric Emergency Department

Ewing, Philip H. MD
Wiebe, Robert A. MD
Brancato, John C. MD
Sharieff, Ghazala MD, FAAP, FACEP, FAAEM

¹Authors
²Assistant Professor, Division of Pediatric Emergency Medicine, University of Texas, Southwestern Medical Center at Dallas, Dallas, TX
³Professor, Division of Pediatric Emergency Medicine, University of Texas, Southwestern Medical Center at Dallas, Dallas, TX
⁴Peer Reviewers
⁵Assistant Professor of Pediatrics and Emergency Medicine; Director, Fellowship in Pediatric Emergency Medicine, University of Connecticut School of Medicine; Children's Medical Center, Hartford, CT
⁶Associate Clinical Professor, Children's Hospital and Health Center/ University of California, San Diego; Director of Pediatric Emergency Medicine, California Emergency Physicians, San Diego, CA

Date of original release: October 1, 2009

Date of most recent review: September 10, 2009

Termination date: October 1, 2012

Medium: Print and Online

Method of participation: Print or online answer form and evaluation Prior to beginning this activity, see “Physician CME Information” on the back page.

Pediatric Emergency Medicine Practice 6(10):p 1-15, October 2009.

A previously healthy 18-month-old girl presented to the emergency department with a 1-day history of poor feeding. On the morning of presentation, she was unarousable, so her parents called EMS. Paramedics arrived to find a somnolent child who was warm and well perfused, with a blood glucose level that was undetectable on a portable glucometer. She was given an infusion of glucose and transported to the ED, where she became somewhat more interactive. Blood and urine samples showed a normal blood sugar level and no ketonuria. The patient was continued on intravenous (IV) fluids containing dextrose and admitted to the hospital for observation. Her clinical course was unremarkable until that night, when she was weaned from IV fluids. At 4 am, her blood glucose level measured 47 mg/dL, and she was unarousable. As glucose was given, a more extensive laboratory panel was drawn, and her urine was collected a second time. The patient's diagnosis was made on the basis of these samples.