Pediatric emergency medicine trisk 464

Fungal Infections
Hawkins DM, Smidt AC. Superficial fungal infections in children. Pediatr Clin
North Am 2014;61(2):443–455.
Honig PJ, Caputo GL, Leyden JJ, et al. Microbiology of kerions. J Pediatr
1993;123:422–424.
Honig PJ, Caputo GL, Leyden JJ, et al. Treatment of kerions. Pediatr Dermatol
1994;11:69–71.
Jensen RH, Arendrup MC. Molecular diagnosis of dermatophyte infections. Curr
Opin Infect Dis 2012;25(2):126–134.
Hemangiomas
Iacobas I, Burrows PE, Frieden IJ, et al. LUMBAR: association between
cutaneous infantile hemangiomas of the lower body and regional congenital
anomalies. J Pediatr 2010;157(5):795–801.
Johnson EF, Smidt AC. Not just a diaper rash: LUMBAR syndrome. J Pediatr
2014;164(1):208–209.
Metry DW, Dowd CF, Barkovich AJ, et al. The many faces of PHACE syndrome.
J Pediatr 2001;139:117–123.
Metry DW, Hebert AA. Benign cutaneous vascular tumors of infancy: when to
worry, what to do. Arch Dermatol 2000;136:905–914.
Urticaria
Berstein JA, Lang DM, Khan DA, et al. The diagnosis and management of acute
and chronic urticarial: 2014 update. J Allergy Clin Immunol 2014;133(5):1270–
1277.
Ghosh S, Kanwar AJ, Kaur A. Urticaria in children. Pediatr Dermatol
1993;10:107–110.
Zuberbier T, Aberer W, Asero R, et al. The EAAC1/GA(2) LEN/EDF/WAO
Guideline for the definition, classification, diagnosis and management of
urticarial: the 2013 revision and update. Allergy 2014;69(7):868–887.
Warts and Molluscum
Brown J, Janniger CK, Schwartz RA, et al. Childhood molluscum contagiosum.
Int J Dermatol 2006;45:93–99.

Kwok CS, Gibbs S, Bennett C, et al. Topical treatments for cutaneous warts.
Cochrane Database Syst Rev 2012;9:CD001781.
Olsen JR, Gallacher J, Piguet V, et al. Epidemiology of molluscum contagiosum
in children: a systemic review. Fam Pract 2014;31(2):130–136.


Smolinski KN, Yan AC. How and when to treat molluscum contagiosum and
warts in children. Pediatr Ann 2005;34:211–221.
Congenital Herpes Simplex
Antaya RJ, Robinson DM. Blisters and pustules in the newborn. Pediatr Ann
2010;39(10):171–179.
Berardi A, Lugli L, Rossi C, et al. Neonatal herpes simplex virus. J Matern Fetal
Neonatal Med 2011;24(suppl 1):88–90.
Brown ZA, Selke S, Zeh J, et al. The acquisition of herpes simplex virus during
pregnancy. N Engl J Med 1997;337:509–515.
Brown ZA, Vontver LA, Benedetti J, et al. Effects on infants of a first episode of
genital herpes during pregnancy. N Engl J Med 1987;317:1246–1251.
Kimberlin DW, Lin CY, Jacobs RF, et al. Natural history of neonatal herpes
simplex virus infections in the acyclovir era. Pediatrics 2001;108:223–229.
Kimberlin DW, Lin CY, Jacobs RF, et al. Safety and efficacy of high-dose
intravenous acyclovir in the management of neonatal herpes simplex virus
infections. Pediatrics 2001;108:230–238.
Kimberlin DW. Herpes simplex virus infections in neonates and early childhood.
Semin Pediatr Infect Dis 2005;16:271–281.
Pityriasis Rosea
Chuh AA, Dofitasa BL, Comisel GG, et al. Interventions for pityriasis rosea.
Cochrane Database Syst Rev 2007;2:CD005068.
Drago F, Broccolo F, Rebora A. Pityriasis rosea: an update with a critical
appraisal of its possible herpesviral etiology. J Am Acad Dermatol
2009;61(2):303–318.

Drago F, Rebora A. Treatments for pityriasis rosea. Skin Therapy Lett
2009;14(3):6–7.
Hartley AH. Pityriasis rosea. Pediatr Rev 1999;20:266–269.


CHAPTER 89 ■ ENDOCRINE EMERGENCIES
KATE DORNEY, MICHAEL S.D. AGUS

KEY POINTS


DKA/Hyperglycemia
1% of children with diabetic ketoacidosis will develop clinically significant cerebral
edema
Risk factors for cerebral edema include elevated blood urea nitrogen, low Pco2 ,
treatment with bicarbonate, failure of serum Na to rise steadily with correction of
hyperglycemia, age <3 years, new-onset diabetes
Hyperglycemia in ED setting can result from numerous triggers including
intercurrent illness or trauma in patient with known DM, new-onset DM, other
illnesses associated with hyperglycemia, spurious sample, medication effect
Hypoglycemia
Prompt recognition of hypoglycemia is important to avoid adverse outcomes
Hypoglycemia in absence of ketones is consistent with hyperinsulinism or fatty acid
oxidation enzyme deficiencies
Hypopituitarism
The acute presentation of hypopituitarism is most likely to occur when the child is
stressed by injury, illness, or fasting
Children with hypopituitarism are prone to hypoglycemia
Congenital hypopituitarism is associated with intracranial developmental anomalies
or lesions

Adrenal Insufficiency/Congenital Adrenal Hyperplasia
Cortisol and aldosterone replacement in patients with primary adrenal insufficiency
under stress conditions is imperative
ED presentations include Addisonian crisis, ambiguous genitalia, acute saltwasting crisis, and precocious puberty
Patients with acute salt-wasting crisis must be recognized and treated immediately
with fluid resuscitation, stress dose hydrocortisone, careful monitoring of
electrolytes
Pheochromocytoma
Often presents with headache, palpitations, sweating; but also nervousness,
tremulousness, fatigue, chest/abdominal pain, and flushing
Most associated with hypertension although can be paroxysmal; alpha blockade is
antihypertensive of choice, avoid pure beta blockade as can lead to severe
hypertension
Diabetes Insipidus
Inability of kidneys to concentrate urine resulting in polyuria/polydipsia
Hypertonic dehydration if thirst is not intact or access to fluids is restricted; if occurs
abruptly, patient at risk for central pontine myelinolysis
Consider in patients with increased urine excretion, enuresis, and increased thirst