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may reveal leukocytosis and/or thrombocytosis CSF usually shows a pleocytosis, with a lymphocytic predominance Sterile pyuria is sometimes noted In some cases of Kawasaki disease, findings consistent with myocardial ischemia or an arrhythmia may be noted on ECG, and coronary artery aneurysms may be discovered with an echocardiogram Endocrine Disorders (See Chapter 89 Endocrine Emergencies ) Infants with congenital adrenal hyperplasia (CAH) usually present in the first few weeks of life with a history of vomiting, lethargy, or irritability Signs of marked dehydration may be present with tachycardia and possibly hypothermia History may reveal that these infants have been poor feeders since birth and the symptoms may be progressive over a few days The physical examination can be helpful in females if ambiguous genitalia are noted The presence of marked hyponatremia with severe hyperkalemia on laboratory evaluation suggests CAH Other findings in this disorder include hypoglycemia and metabolic acidosis Evaluate for peaked T waves or arrhythmias on ECG as hyperkalemia may result in sudden cardiac arrest Elevated 17-hydroxyprogesterone and renin, with decreased serum aldosterone and cortisol, confirm the diagnosis of CAH Metabolic Disorders Prolonged diarrhea or vomiting can produce hypoglycemia, dehydration, electrolyte disturbances, and acid–base abnormalities such that an infant will appear quite ill Young infants with diarrhea may develop marked hyponatremia caused by sodium losses or iatrogenic water intoxication The latter occurs when well-meaning parents feed excess free water or improperly mix concentrated formula, leading to a rapid drop in serum sodium Such infants may appear lethargic, with slow respirations, hypothermia, and, possibly, seizures that are difficult to control Likewise, dehydrated infants with hypernatremia may be lethargic or irritable, with muscle weakness, seizures, or coma Persistent vomiting may lead to hypochloremic alkalosis with hypokalemia, causing weakness or cardiac dysfunction (see Chapters 22 Dehydration and 100 Renal and Electrolyte Emergencies ) A special cause of hyponatremic dehydration to consider is cystic fibrosis Vague symptoms in the history include poor feeding, poor growth, and increased lethargy The parents may report that the infant gets ill in hot weather and that the baby’s skin tastes salty The baby may have also had meconium plug syndrome (transient distal colonic obstruction caused by inspissated meconium), prolonged jaundice, or prior pulmonary symptoms such as cough, tachypnea, or pneumonia
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