McCrindle BW, Rowley AH, Newburger JW, et al Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American heart association Circulation 2017;135:e927–e999 Newburger JW, de Ferranti SD, Fulton DR Cardiovascular sequelae of Kawasaki disease: management and prognosis In: Triedman JK, Armsby C, eds UpToDate Waltham, MA Accessed April 17, 2019 Newburger JW, Sleeper LA, McCrindle BW, et al Randomized trial of pulsed corticosteroid therapy for primary treatment of Kawasaki disease N Engl J Med 2007;356:663–675 Portman MA, Dahdah NS, SLee A, et al Etanercept with IVIG for Acute Kawasaki disease: a randomized controlled trial Pediatrics 2019;143(6):e20183675 Son MF, Gauvreau K, Ma L, et al Treatment of Kawasaki disease: analysis of 27 US pediatric hospitals from 2001 to 2006 Pediatrics 2009;124:1–8 Sundel RP Kawasaki disease Rheum Dis Clin N Am 2015;41:63–73, viii Sundel RP Kawasaki disease: Clinical features and diagnosis In: Klein-Gitelman M, Kaplan SL, Tepas E, eds UpToDate Waltham, MA Accessed March 4, 2019 Sundel RP, Petty RE Kawasaki disease In: Cassidy JT, Petty RE, Laxer RM, et al., eds Textbook of Pediatric Rheumatology 6th ed Philadelphia, PA: Saunders Elsevier; 2011:505–520 Tacke CE, Breunis WB, Pereira RR, et al Five years of Kawasaki disease in the Netherlands: a national surveillance study Pediatr Infect Dis J 2014;33(8):793–797 Yellen ES, Gauvreau K, Takahashi M, et al Performance of 2004 American Heart Association Recommendations for Treatment of Kawasaki Disease Pediatrics 2010;125:e234e241 Behỗet Disease Eldem B, Onur C, Ozen S Clinical features of pediatric Behỗets disease J Pediatr Ophthalmol Strabismus 1998;35:159–161 Kone-Paut I, Yurdakul S, Bababri SA, et al Clinical features of Behỗets disease in children: an international collaborative study of 86 cases J Pediatr 1998;132:721– 725 Krause I, Weinberger A Behcet’s disease Curr Opin Rheumatol 2008;20:82–87 Sakane T, Takeno M, Suzuki N, et al Behỗets disease N Engl J Med 1999;341:1284– 1291 Scleroderma Li SC Scleroderma in children and adolescents Localized scleroderma and systemic sclerosis Pediatr Clin North Am 2018;65:757–761 Li SC, Torok KS, Pope E, et al Development of consensus treatment plans for juvenile localized scleroderma: a roadmap toward comparative effectiveness studies in juvenile localized scleroderma Arthritis Care Res (Hoboken) 2012;64(8):1175– 1185 Vehe RK, Riskalla MM Collagen vascular disease: SLE, dermatomyositis, scleroderma, and MCTD Pediatr Rev 2018;39(10):501–515 Zulian F Juvenile systemic sclerosis (scleroderma) In: Sundel R, TePas E, eds UpToDate Waltham, MA Accessed April 16, 2019 Zulian F Localized scleroderma in childhood In: Li SC, Axford JS, Callen J, TePas E, eds UpToDate Waltham, MA Accessed April 17, 2019 Zulian F, Cassidy JT The systemic sclerodermas and related disorders In: Cassidy JT, Petty RE, Laxer RM, et al., eds Textbook of Pediatric Rheumatology 6th ed Philadelphia, PA: Saunders Elsevier; 2011:414–437 Zulian F, Culpo R, Sperotto F, et al Consensus-based recommendations for the management of juvenile localized scleroderma Ann Rheum Dis 2019;78(8):1019– 1024 Mixed Connective Tissue Disease Ito S, Nakamura T, Kurosawa R, et al Glomerulonephritis in children with mixed connective tissue disease Clin Nephrol 2006;66(3):160–165 Pepmueller PH, Lindsley CB, Cassidy JT Mixed connective tissue disease and undifferentiated connective tissue disease In: Cassidy JT, Petty RE, Laxer RM, et al., eds Textbook of Pediatric Rheumatology 6th ed Philadelphia, PA: Saunders Elsevier; 2011:448–457 Tsai YY, Yang YH, Yu HH, et al Fifteen-year experience of pediatric-onset mixed connective tissue disease Clin Rheumatol 2010;29(1):53–58 CHAPTER 102 ■ TOXICOLOGIC EMERGENCIES MADELINE H RENNY, KATHERINE A O’DONNELL, DIANE P CALELLO PEDIATRIC POISONINGS CLINICAL PEARLS Poisoning in the young child is usually exploratory and more likely to involve household products, whereas adolescents more commonly are intentionally self-poisoned by pharmaceuticals or drugs of abuse Initial stabilization of a poisoned patient with altered mental status, in addition to standard resuscitation measures, may include blood glucose determination and empiric naloxone therapy Naloxone dosing can be higher in young children without concern for opioid withdrawal, from 0.4 to mg initially In adolescents with concern for chronic opioid use, a much smaller initial dose of 0.04 mg is appropriate Consultation with the regional poison control center can be extremely helpful in managing the poisoned child In the United States, a single phone number, 1-800-222-1222, will reach the nearest center Standard urine toxicology screens are seldom essential to evaluate poisoned patients The history and focused physical examination are more valuable to determine the nature of exposure in the majority of cases Pertinent diagnostic evaluation in the unknown exposure patient may include serum chemistries, blood gas analysis, serum osmolarity, an electrocardiogram, and quantitative serum acetaminophen, salicylate, and ethanol concentrations Current Evidence Poisoning represents one of the most common medical emergencies encountered by young children and accounts for a significant fraction of emergency department (ED) visits in the adolescent population Estimates of poisoning episodes annually in the United States range in the millions Poisonings may be unintentional or intentional Unintentional or exploratory exposures to poisons make up 80% to 85% or more of all reports, whereas intentional poisonings comprise the other 10% to 15% Persons in this latter group have much higher rates of treatment in the ED, hospitalization, and intensive care Among children years and younger, most poisoning exposures are related to exploratory behavior Although less common, the physician must also consider the possibility of environmental exposures, therapeutic errors, suicide attempts in children, and neonates exposed to toxicants in utero Child abuse by poisoning, while rare, should be suspected in patients outside the typical age for self-poisoning (e.g.,