Therapeutische Umschau. Revue thérapeutique
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The diagnosis of an acute asthmatic attack in a child is made on a clinical basis. The severity of the exacerbation can be assessed by physical examination and measurement of the transcutaneous oxygenation saturation. A blood gas analysis can be helpful in this assessment. ⋯ Clinical response to initial treatment is the main criterion for hospital admission. Patients with failure to respond to treatment should be transferred to an intensive care unit. A critical aspect of management of the acute asthma attack in a child is the prevention of similar attacks in the future.
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The child who presents with acute coma runs a high risk of cardiopulmonary insufficiency, direct brain injury or even cerebral herniation. The case-management of such child requires a coma-specific emergent evaluation, immediate treatment of any hypoxicischemic insults and of the underlying cause. The coma-specific examination includes performance of child-adapted Glasgow Coma Score, the evaluation of brain stem functions such as pupillary response to light, cough- and gag reflex, and determination of all vital signs including body temperature. ⋯ Immediately treatable causes are hypoglycemia, meningitis/encephalitis, opioid overdose and status epilepticus. Exclusion of rapidly progressive intracranial lesions almost always requires referral to the tertiary centre with head CT-scan facilities. Finally, an extensive etiology search of the stable coma is performed by looking for disease or trauma of the brain, for metabolic causes, for intoxications and for cardiopulmonary problems.
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Acute dyspnoea is one of the most frequent paediatric emergencies in clinical practice. The anatomy of paediatric airways is different from that of adults. ⋯ A careful history and physical examination usually provides valuable guidance in the evaluation of the child with acute dyspnoea. Prompt recognition and appropriate treatment of imminent respiratory insufficiency are criticalfor excellent prognosis and will minimise the risk of long-term complications.
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Electrolyte disturbances are frequently encountered in pediatric patients, not only in those with critical illness. They can manifest as lethargy, seizures, vomiting and cardiac arrhythmias. ⋯ Before initiating treatment, potential risks of both, the electrolyte disorder itself and the treatment must be considered. Therefore, long lasting (chronic) disorders must in general be corrected very slowly, whereas in acute disturbances rapid correction is better tolerated.
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The WHO announced diabetes mellitus as one of the main threats to human health in the 21st century. In children and adolescents the prevalence of both the autoimmune type 1 and the obesity-related type 2 diabetes is increasing. Common to all types of diabetes is an absolute or relative lack of insulin to keep glucose homeostasis under control. ⋯ Severe hypoglycemia with or without seizures may bring the diabetic child in a sudden emergency situation for which the administration of glucagon intramuscularly or glucose intravenously is mandatory. After every severe hypoglycemia the insulin and diet regimen of the diabetic child or adolescent must be reviewed with the diabetes specialist. For unexplained hypoglycemia or major treatment adjustments the diabetic child or adolescent may need to be readmitted to the diabetic ward of a hospital to avoid repeat, potentially life-threatening hypoglycemia.