Clinical pediatrics
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Diabetic ketoacidosis (DKA), resulting from severe insulin deficiency, accounts for most hospitalization and is the most common cause of death, mostly due to cerebral edema, in pediatric diabetes. This article provides guidelines on management to restore perfusion, stop ongoing ketogenesis, correct electrolyte losses, and avoid hypokalemia and hypoglycemia and the circumstances that may contribute, in some instances, to cerebral edema (overhydration, rapid osmolar shifts, hypoxia). These guidelines emphasize the importance of monitoring glycemia, electrolytes, hydration, vital signs, and neurologic status in a setting where response can be rapid if necessary (e.g., mannitol for cerebral edema). Most important is the prevention of DKA in established patients by close supervision of those most likely to omit insulin, or during illness, and a high index of suspicion for diabetes to prevent deterioration to DKA in new patients, particularly those under age 5, who are at greatest risk of complications.
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Clinical pediatrics · May 1996
Weight gain: a possible factor in deciding timing for inguinal hernia repair in premature infants.
A retrospective study was done to determine whether improved weight gain follows inguinal hernia repair in the premature infant and whether the presence of an inguinal hernia is associated with comparatively poorer weight gain prior to repair. Demographic and growth data from 28 premature infants who had undergone hernia repair were compared with corresponding data from 25 matched "control" premature patients. ⋯ The differences found in Z scores between these two groups indicated that premature infants who have inguinal hernias seem to grow better after the hernia repair as compared with before the surgery. Despite issues related to group matching, the results of this study indicate that weight gain may be an additional factor to consider in determining the appropriate time to do surgical correction of a premature infant's inguinal hernia.