Pediatric emergency medicine trisk 4123 4123

Signs and Symptoms
Abdominal Distension: Chapter 12
Diarrhea: Chapter 23
Gastrointestinal Bleeding: Chapter 33
Pain: Abdomen: Chapter 53
Medical, Surgical, and Trauma Emergencies
Cardiac Emergencies: Chapter 86
Renal and Electrolyte Emergencies: Chapter 100

POSTTRANSPLANT INFECTIOUS COMPLICATIONS
CLINICAL PEARLS AND PITFALLS
Presentation of infectious conditions in a transplant recipient may range
from benign to uncharacteristically severe.
Early identification of infectious etiologies allows for directed treatment.
Patients on immunosuppression may not mount fever or elevated white
blood cell count.
Significant infections, such as bacterial sepsis or varicella, may
progress rapidly.
Unusual infections should be considered in immunocompromised
patients with clinical signs or symptoms.
Avoid NSAIDs for antipyresis in patients taking calcineurin inhibitors
(CNIs) (e.g., cyclosporine, tacrolimus). In combination, these drugs can
cause acute renal insufficiency.
Fever and elevated aminotransferases may be a sign of infection,
rejection, or venous thrombosis in the pediatric liver transplant patient.

Current Evidence
In the immediate posttransplant period, the transplant patient is at risk for
bacterial, viral, and fungal infections. Etiologies of the increased infectious
susceptibility include high-dose immunosuppression and indwelling central
venous access. Bacterial sources of infection include wound infection, urinary

tract infection, and central-line infections. Both gram-positive organisms, such as
staphylococcal or streptococcal species, and gram-negative organisms, especially