Pediatric emergency medicine trisk 2668 2668

Diagnostic evaluation Immediate supportive care • Detailed medical history • Determine need for platelet or red blood cell • Complete physical examination (including transfusion testicular and external perineal examination) • IV fluids to maintain urine • CBC count with manual differential and output peripheral blood smear • Initiation of uric acid– • Electrolytes, including potassium, calcium, lowering agents phosphorus (allopurinol or rasburicase) • Uric acid • Consideration of broad• Assessment of renal function with BUN and spectrum antibiotics in creatinine febrile or ill-appearing • Coagulation studies, PT, PTT patients • Blood group type, antibody screen • Liver function tests • Chest x-ray to assess for mediastinal mass • Blood culture (if febrile or ill appearing) Specific problems that require immediate intervention Problem Required data/findings Therapy/management Prevention of TLS a Frequent laboratory monitoring (q6–8h) Uric acid Electrolytes BUN and creatinine Ca and PO4 IV fluids run at 1.5–2 × maintenance Allopurinol Monitor urine output IV fluids as above Allopurinol or rasburicase Hyperuricemia Rasburicase, if renal function is impaired at presentation, if uric acid levels are rapidly rising or extremely high, or if there is a contraindication to hyperhydration Furosemide, insulin/glucose, kayexalate EKG No replacement of potassium Hyperkalemia Hypokalemia