Pediatric emergency medicine trisk 2286 2286

TABLE 94.15
CLINICAL AND LABORATORY FINDINGS IN KAWASAKI DISEASE

Clinical assessment: Supporting laboratory criteria are described in Table 94.24 . In children with elevated
inflammatory markers with at least 5 days of fever and 2 or 3 clinical criteria, or in infants with at least 7 days of
fever without explanation, incomplete KD should be suspected if the children have at least three associated
laboratory findings: leukocytosis (≥15,000/mm3); anemia; thrombocytosis (≥450,000/mm3), hypoalbuminemia
(≤3 g/dL), elevated ALT, or pyuria (≥10 WBC/HPF).
Management: The treatment for KD is intravenous immunoglobulin (IVIG) at 2 g/kg as a single dose given over
10 to 12 hours. In addition, children should be started on high-dose aspirin (80 to 100 mg/kg/day divided every 6
hours). An echocardiogram should be ordered. A clinician’s threshold for treating should be lower as a child
approaches day 10 of fever than it is at day 5. Standard precautions should be used.

Other Cardiac Infectious Emergencies
Goals of Treatment
ED recognition of new cardiac infections is poor, especially in the child without pre-existing structural heart
disease. For example, most children with myocarditis are missed at the time of initial ED presentation. Recognition
of children at risk for endocarditis, as well as the most common manifestations of myocarditis and pericarditis, can
prevent the ED physician from inadvertently worsening cardiac function from rapid fluid resuscitation.
CLINICAL PEARLS AND PITFALLS
Infective endocarditis is most common in children with structural heart disease, but increased rates of
S. aureus endocarditis in children with normal heart valves have recently been described.
The most common sign of myocarditis is unexplained tachycardia.
The chest radiograph in a child with pericarditis and a large pericardial effusion may be normal.
Bedside ultrasound can provide rapid assessment for pericardial effusion and contractility.