Paediatric Hypoglycaemia (BM <2.6) is a relatively common presentation in the Emergency Department. However, if we don’t do the BM it’s easy to miss.
Hypoglycaemia in paediatric diabetic patients is managed separately – see here
Hypoglycaemia in neonates (<72 hours of life) also has specific management – see here (Flowcharts A + B)
Hypoglycaemia is generally caused by disruption in one of the following:
Diabetic Ketoacidosis – remember in paediatrics this may be the 1st presentation of diabetes.
DKA Management Flow Chart – HERE
Diabetic children sometimes attend ED with hyperglycaemia, but not in DKA (what should we do?)
Paeds have produced some advice to follow:
Time Critical Medication (TCM) is scheduled medication that the patient is already on when they present to the Emergency Department (ED).
The medications are “time critical” because a
delayed or missed dose can result in harm with exacerbation of symptoms and the development of complications leading to an increased mortality.
Movement disorders – Parkinson’s / Myasthenia medication
Immunomodulators including HIV medication
Sugar (Insulin)
Steroids – Addison’s and adrenal insufficiency
Epilepsy – anticonvulsants
DOACs and warfarin
Its really important for our patients that these medications are prescribed and given while in ED/uSDEC/fSDEC.
If you are withholding these medication (which may be necessary) -please the reason for this clearly in the notes.
HHS (A.K.A. HONK) is a diabetic emergency, but unlike DKA we don’t always think about it.
Patients with HHS are often elderly with multiple co-morbidities, and they are always very sick.
When patients sent in by GP “” – how much do you do?
* Examples of High Risk Patients: Dialysis, Renal Transplant, CKD under renal team. Previous Hyperkalaemia.
** All patients being discharged need to be discussed or seen by a Tier 3+ level Dr who will assign themselves to the patient. Put the Diagnoses as ‘No abnormality Detected’ AND ‘Potassium Level.’
Patients POC results, ECG and PMH reviewed.
Make sure the patients contact number is correct. Inform them if their lab result comes back high then we will contact them. OPer them the choice if the result is normal – would they like a phone call or not. Add their choice to the bubble I.e ‘no call’ ‘wants call’
Move the patient to the ‘Streaming’ Tab and record the time they left in the bubble. Once the lab result is back, if it is raised then recall the patient for treatment. If it is normal then discharge from the system ensuring to put the discharge time as when they left the department.
If the lab sample haemolyses – The decision to recall is at the discretion of the Tier 3+ doctor.
This pathway has been created as a guide to help reduce the investigation burden and length of stay of patients with pseudo-hyperkalaemia. The purpose of having an Tier 3+ level doctor responsible for these patients is they can make a quick global assessment of the patient and decide whether the patient is high risk and if the streaming pathway is appropriate, rather than relying on a regimented list of conditions or parameters.
In hours this should be done by the front door doctor. Out of hours Tier 1/2 doctors can still see these patients but they should then be discussed with a Tier 3+ Doctor.
Thanks to Dr Stuart Mitchell
Hyponatraema is a common finding, especially within our elderly population. However, its significance is is not a simple numbers game, and needs senior input. Prior to treatment the following need to be considered and balanced.
Some patients present to ED with symptoms or investigations suspicious an undiagnosed cancer, but don’t require emergency admission. To reduce the barriers to care the trust has implemented a referral route for ED.
Once completed the PPC team will review the request and feed them into either “Fast-Track Clinics” if further workup required or MDT’s if fits those pathways.
This should allow our patients quick access to appropriate clinics, without the inherent delays and wasted clinical time of asking the patient to attend their GP. BMA/NHSe
Remember: is it a haemolysed blood sample? (you can do an iSTAT)
Severity
