Pediatric emergency medicine trisk 2668 2668

Diagnostic evaluation
Immediate supportive care
• Detailed medical history
• Determine need for platelet
or red blood cell
• Complete physical examination (including
transfusion
testicular and external perineal examination)
• IV fluids to maintain urine
• CBC count with manual differential and
output
peripheral blood smear
• Initiation of uric acid–
• Electrolytes, including potassium, calcium,
lowering agents
phosphorus
(allopurinol or rasburicase)
• Uric acid
• Consideration of broad• Assessment of renal function with BUN and
spectrum antibiotics in
creatinine
febrile or ill-appearing
• Coagulation studies, PT, PTT
patients
• Blood group type, antibody screen
• Liver function tests
• Chest x-ray to assess for mediastinal mass
• Blood culture (if febrile or ill appearing)
Specific problems that require immediate intervention
Problem

Required data/findings

Therapy/management

Prevention of TLS a Frequent laboratory
monitoring (q6–8h)
Uric acid
Electrolytes
BUN and creatinine
Ca and PO4

IV fluids run at 1.5–2 ×
maintenance
Allopurinol
Monitor urine output
IV fluids as above
Allopurinol or rasburicase

Hyperuricemia

Rasburicase, if renal function
is impaired at presentation,
if uric acid levels are
rapidly rising or extremely
high, or if there is a
contraindication to
hyperhydration
Furosemide, insulin/glucose,
kayexalate
EKG

No replacement of potassium

Hyperkalemia

Hypokalemia