July 2019 PDF

July 2019:  Honing in on coca cola coloured urine this month and a closer look at armpits.  Links to suitable child safeguarding CPD on harmful sexual behaviour and a look at the ANA test.  Do leave comments below.

June 2019 newsletter

Possible causes of macrocephaly this month.  Also the start of a new series on causes of coca-cola coloured urine and updates on safeguarding CPD requirements and the terminology of children “in care”.  Do leave comments below:

April and May became combined this year…

April came and went a bit too fast for my Paediatric Pearls head.  So I’ve produced a joint April/May newsletter for 2019.  There’s a bit of safeguarding again this month with a link to a paper on what young people in care think of the language we use, a guide to enteral rehydration of children with D&V, acrodermatitis enteropathica and a reminder of what is normal on a paediatric ECG.  Do leave comments below:

It is safer to rehydrate children with D&V enterally than intravenously

I got a few blank faces on a ward round recently when I was working out volumes of diarolyte for rehydrating a child with D&V.  We tend to use “5mls every 5 minutes” in our Emergency Departments whatever the size of the child and however dehydrated they are and then, when they fall asleep and we want to move them out of our department for fear of 4-hour breaches, we put an iv line in, take bloods which we then have to act on and start iv fluids which we should then monitor more often than most of us do.  Where is the half way point?

Have a look at http://www.paediatricpearls.co.uk/wp-content/uploads/Fluid-management-in-childhood-gastroenteritis.pdf for some help with enteral rehydration (which is safer and more efficient overall than intravenous fluids).  Please let me know if you disagree with my calculations and work them all out for yourself from scratch if you happen to be dealing with a 16kg child like in the worked example…

March 2019 PDF published

Part 2 of Medically Unexplained Symptoms this month.  Also antibiotics in cystitis, too many investigations in community acquired pneumonia, carotenaemia and heart murmurs in unwell children.  Do leave comments below:

February 2019 newsletter

NICE on honey this month.  And antibiotics in URTIs.  Also blueberry muffin syndrome courtesy of our dermatology contributor, medically unexplained symptoms from a great on line resource from MindEd (https://www.minded.org.uk/Component/Details/525083) and information for practitioners and young people and families after a first afebrile seizure.  Please do leave comments below:

January 2019 newsletter

Genetics this month and an explanation of the microarray test.  Managing measles contacts in the “lessons from the front line” section, use of a smartphone app for recording palpitations and the start of a new dermatology series – skin manifestations of systemic disease.  Do leave comments below.

December 2018 PDF

Christmas disease this month, acute psychosis in children, an Emoji guide to the workings of the facial nerve, sleep hygiene and the start of a 2 part series on measles.  Happy New Year and do leave comments below!

November 2018 published

STIs, sexual abuse, eating disorder and haemolytic uraemic syndrome this month.  Do leave comments below:

Haemolytic Uraemic Syndrome (HUS)

With thanks to Dr David Gardiner, one of our current paediatric FY2 doctors at Homerton University Hospital, for updating us on HUS.

News story in 1999

News story from 2018.  Less than 3% of patients die of HUS but 20-30% experience adverse renal outcomes.  Think about it in children with bloody diarrhoea and, often, no fever.

Presentation:

  • Profuse diarrhoea that typically turns bloody after 1-3 days
  • Abdominal pain (crampy)
  • Vomiting
  • Fever (sometimes)
  • Oedema
  • Reduced urine output (abrupt onset) but also polyuria/normal urine output (rarer)
  • Neurological complications: seizure, coma, cranial nerve palsies, confusion, hallucinations
  • Classic triad – anaemia, uraemia and thrombocytopaenia
  • Most common in children under the age of 5

Investigations:

  • B/P – hypertension
  • Blood film: Fragmentation and signs of haemolysis (Coombs test negative)
  • Raised WCC and neutrophils, low platelets, low Hb
  • Raised LDH
  • Clotting screen typically normal (cf DIC)
  • Raised bilirubin, low albumin
  • Urea and creatinine raised
  • Stool for PCR E.Coli

Management:

  • Refer to secondary care urgently
  • Strict input/output fluid monitoring
  • Correction of anaemia
  • Correction of electrolyte imbalances
  • Antihypertensive therapy if required
  • Dialysis
  • Furosemide to induce diuresis
  • Report to PHE – can’t go back to school until 2 negative stool samples

More resources:

Kidney Research website on HUS

https://patient.info/doctor/haemolytic-uraemic-syndrome-pro#ref-8