Raised intracranial pressure this month, nappy rash, complex febrile seizures, tingling side effects of recreational nitrous oxide use and Vitamin D – again….
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Retinoblastoma mnemonic this month. Plus information on lower sugar content recipes for the reintroduction of cows milk into a child’s diet, labial adhesions, 6 in 1 vaccine and don’t miss infantile spasms as early treatment improves overall prognosis. Do leave comments below.
Children’s cancer information this month – prevalence and red flags, a link to the excellent immunisation resource – Oxford vaccine group – for all those questions about individual immunisations that you can’t always answer, NICE’s recent UTI update and infant dyschezia. Do leave comments below.
Local anaesthetic cream this month (why do some places not use it in the under 1’s?), a link to useful “flash card” learning in the paediatric ED from Leicester, new Movicol doses, diphtheria and the last instalment of urinalysis with bilirubin and urobilinogen. A reminder also to please discuss children with glycosuria and a high BM with a paediatrician – most children have type 1 diabetes and are at risk of DKA at diagnosis. Do leave comments below:
www.lifeinthefastlane.com has a great article describing the components of the humble urine dipstick and what we might learn from it. It is available here and I am going to borrow extensively from Dr Mike Cadogan’s work over the next few months but try to put a paediatric slant on it.
Normal range varies by lab but roughly 1.005 to 1.030
< 1.005 – diabetes insipidus, fluid overload, pyelonephritis
> 1.030 – dehydration, glycosuria, SIADH
Falsely high in proteinuria, falsely low in alkaline urine
Glomerular filtrate has a pH of about 7.4 which is acidified to about 6 by the time it is passed as urine.
Causes of alkaline urine (⇑pH)
Causes of acidic urine (⇓pH)
Old sample, vegetarian diet, salicylate
overdose, UTI, citrus fruit ++, low carb diet
Metabolic/respiratory acidosis, diarrhoea, high
protein diet, DKA, cranberries, malabsorption
Nitrites on a dipstick test has a positive predictive value of 96% ie. it is highly likely that the child has a UTI. But the test’s negative predictive value is not so good (around 70%) ie. some children still have a UTI even though they have no nitrites in their urine. Why?
The current NICE UTI guideline recommends microscopy and culture to rule out UTI in children younger than 3 but suggests that dipstick urinalysis is enough in older children. They are currently looking at new evidence to see if the dipstick result (leucocytes and nitrites) can be “trusted” in younger children. Update due to be published this year.
|Dipstick protein reading||Protein excretion gm/24 hours||Protein excretion mg/dL|
|1+ (and above is abnormal)||0.2-0.5||30|
Ketones are not normally found in the urine. Produced by the liver as intermediate products of fatty acid metabolism, in normal states they will be completely metabolised. In “starvation” states eg. DKA or vomiting and reduced intake, fever, extreme cold and extreme exercise, the body metabolises increased fat to get the energy it needs to keep functioning. This results in ketonuria. ≥ ++ is abnormal. We often see ketones in the urine of unwell children in the ED. When glucose is present at the same time in the urine, diabetic ketoacidosis is the likely diagnosis.
We welcome back Dr Marilyn Emedo for a series on pooing and constipation throughout infancy. First Installment: What is Normal?
BREASTFED newborn babies stool anywhere between 7 times a day and once every 7-10 days. Stool is commonly “loose” in consistency and yellow in colour resembling “mustard seeds”. A reduction in frequency is typically seen from the 2nd month of life. 1
BOTTLE FED babies tend to open their bowels fewer times per day.
In 90% of normal term babies, meconium (intestinal epithelial cells, lanugo, mucus, amniotic fluid, bile, and water) is passed within 24 hours of birth and by 48 hours in nearly all normal babies.2
Preterm infants may take longer than this to first open their bowels; one study reported only 37% of preterm infants (25 -36 weeks gestation) open their bowels in the first 24 hours, and 32% are delayed over 48 hours. The ongoing frequency of stool output, and expected colour and consistency thereafter depends largely on what the baby is being fed.
Haematuria this month with links to an algorithmic Australian guideline on how to manage it in children, assessing paediatric hypertension, postural orthostatic tachycardia syndrome and the last for the time being in the “decoding the FBC” series – MCHC.
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