Condition Major clinical features Diabetic ketoacidosis Polyuria, polydipsia, Blood glucose, pH dehydration, ketotic breath, hyperpnea, nausea, vomiting, abdominal pain, coma 0.9% saline 10 mL/kg in first 1–2 hrs IV; insulin infusion 0.1 Unit/kg/hr; later, may need KAcetate 10–60 mEq/L and KPhos 10–20 mEq/L Hypoglycemia Older child : hunger, sweatiness, dizziness, convulsions, coma Neonate : apnea, hypotonia, hypothermia, irritability, tremor, convulsions Ambiguous genitalia in females; poor feeding, weight loss, irritability, vomiting, dehydration Nausea, vomiting, abdominal pain, weakness, malaise, hypotension, dehydration, hyperpigmentation 25% dextrose 1–2 mL/kg IV bolus or 10% dextrose 5–10 mg/kg/min IV infusion, glucagon 0.5–1 mg IM stat (if hyperinsulinism) Congenital adrenal hyperplasia Adrenal insufficiency Hypercalcemia Headache, (hyperparathyroidism) irritability, anorexia, constipation, polyuria, polydipsia, dehydration, hypertension Urgent investigations Blood glucose Serum for growth hormone, cortisol, insulin; first-voided urine for organic acids and toxin screen Initial treatment Plasma sodium, 0.9% saline 20 potassium, glucose, mL/kg in first 17hour IV; hydroxyprogesterone; hydrocortisone karyotype and pelvic 25 mg IV stat ultrasound (neonatal dose) Plasma sodium, Hydrocortisone potassium, glucose, 100 mg IV stat; cortisol, and ACTH 10% dextrose in (for retrospective 0.9% saline 20 confirmation of mL/kg in first diagnosis) hour Plasma calcium, phosphate 0.9% saline at two to three times maintenance rate; furosemide mg/kg