PAEDIATRICS

ResponseAcidosis - HAGMA +/- NAGMA from bicarb losses or renal- Acidosis indicates mineralocorticoid deficiency
Respiratory compensation - Reduced GCS/hyperventilation
Hyperkalaemia + Hyponatraemia - mineralocorticoid deficiency
Hypoglycaemia - Low in cortisol deficiency
Hypochloraemia - vomiting
Lactate

ResponseCAH
Congenital heart disease
Dehydration
Renal failure
Sepsis
GI disorder - Malritation, pyloric stenosis, Necrotising enterocolitis, intussusception
Inborn error of metabolism (lethargy, history of seizure)
Endocrine disorders
Heart failure
THE MISFITS

ResponseInvestigations ideally prior to steroid administration
Cortisol
17 hydroxyprogesterone
Plasma renin
ACTH level
Urinary steroid profile

EUC - hyponatraemia + hyperkalaemia
Blood gas
Blood glucose (formal and bedside) - low = cortisol insufficiency

ResponseSeverely unwell if unstable or unwell (Vomiting/diarrhoea/drowsy)
Steroid replacement

• 25 mg IV/IM (up to age 3) then 5-10 mg Q6h
• Fludrocortisone 0.05- 0.1mg (not really needed acutely though)

IV fluids

• 10-20 mL/kg N/S + repeat until circulation restored - SBP>80, CRT <3s
• Remaining deficit + maintenance over next 24h N/S+5%
• Gas + EUC monitoring Q2h

Treat hypoglycaemia

• Bolus 10% dextrose 2-5 mL/kg + recheck 30 mins. Target >4
• Can increase to 10% dextrose + N/S if needing to

Hyperkalaemia

• ECG if K>6
• Calcium gluconate 0.5 mL/kg + insulin infusion 0.1 u/kg/h

Precipitating illness/injury

• Seek and treat precipitating illness

Consultation with paediatrics for admission + PICU
Emperic antibiotics
RCH + some answers added in