pericarditis) Metabolic acidosis due to inborn errors of metabolism Toxic overdose Hemolytic uremic syndrome Diabetic Sepsis ketoacidosis Sepsis Myocarditis, pericarditis Sepsis Diabetes mellitus (infection or ketoacidosis) Diabetic Drug ketoacidosis abuse/overdose Collagen vascular disease Hemolytic uremic syndrome a Alcohol, amphetamines, aspirin, insecticide, iron, lead, phencyclidine, plants, etc Functional abdominal pain should be considered among children with recurrent abdominal pain, but should be a diagnosis of exclusion The pain rarely occurs during sleep and has no particular associations with eating, exercise, or other activities The child typically has normal growth and development, and the abdominal examination is unremarkable; occasionally, mild midabdominal tenderness, without involuntary guarding, is elicited Among postmenarchal females, life-threatening conditions within the reproductive tract that can cause abdominal pain include pelvic inflammatory disease (PID) with tubo-ovarian abscess and ruptured ectopic pregnancy Although intrauterine pregnancy may be associated with lower abdominal pain, ectopic pregnancy should always be considered EVALUATION AND DECISION The first priority is the stabilization of the seriously ill or injured child Attention to airway, breathing, and circulation is critical because cardiorespiratory disease and shock may present with abdominal pain as the major complaint and abdominal emergencies left untreated or with deterioration can lead to cardiorespiratory failure The next priority is to identify the child who requires immediate or potential surgical intervention, whether for a traumatic injury, appendicitis, intussusception, or other congenital or acquired lesions Third, an effort is directed to diagnose any of the medical illnesses from among a large group of acute and chronic abdominal and extra-abdominal inflammatory disorders that require emergency nonoperative management Table 53.2 lists lifethreatening causes of abdominal pain by age groups Finally, the physician should