Clinical pediatrics
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Clinical pediatrics · Apr 2009
Review Case ReportsAcute hemorrhagic edema of infancy: report of 4 cases and review of the current literature.
Acute hemorrhagic edema of infancy (AHEI) is a cutaneous leukocytoclastic vasculitis that usually occurs in children younger than 2 years of age. It is a rare disease characterized by mild fever, a violent onset of hemorrhagic skin lesions, and edema usually followed by a spontaneous and complete recovery. Although the etiology is unknown, AHEI often follows infections, drug treatment, or vaccination. In the present report, the authors describe 4 cases of AHEI and review the relevant literature.
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Clinical pediatrics · Apr 2009
Predictors of pediatric emergency patients discharged against medical advice.
Based on a retrospective 5-year medical record review, this study characterizes factors associated with patients discharged against medical advice (AMA) from a tertiary pediatric emergency department (ED) and compares rates of return to the ED and admission to the hospital with those of patients routinely discharged. Data from 94 patients discharged AMA are compared with those of 188 control patients. Pediatric patients at risk for discharge AMA are older than 15 years (odds ratio [OR], 3.561; 95% confidence interval [CI], 1.695-7.482), self-register independent of a parent (OR, 3.100; 95% CI, 1.818-152.770), arrive by ambulance (OR, 2.761; 95% CI, 1.267-6.018), involve a consultant (OR, 2.592; 95% CI, 1.507-4.458), and have a chief complaint of abdominal pain (OR, 3.095; 95% CI, 1.154-8.303). ⋯ Adolescents who register themselves are at increased risk for discharge AMA. Patients who are triaged as urgent or nonurgent or who have minor illnesses are likely to be dispositioned routinely. Patients discharged AMA are more likely to return to the ED with the same complaint than patients who are routinely discharged.
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This case discussion is part of the Integrating Basic Science Into Clinical Teaching Initiative. It examines the presentation of altered mental status and describes the underlying physiology, which explains the basic laboratory findings in an attempt to reach a diagnosis. This article describes a 13-year-old boy who presented to the emergency department with altered mental status after being found unconscious and alone in an abandoned building. ⋯ Subsequent investigation confirms a diagnosis of ethanol toxic effects. An understanding of electrolyte and acid-base physiology allows the clinician to use basic laboratory studies to build a focused differential diagnosis for altered mental status. This case discussion demonstrates how basic science principles of anatomy and physiology can be applied in clinical settings.