Recognition and treatment of endocrine/metabolic emergencies in children: part I.

A wide variety of endocrine/metabolic emergencies exists that may be isolated occurrences, the initial manifestation of an endocrine/metabolic disorder (eg, diabetes mellitus or hypoparathyroidism), or an acute abnormality in a child with known endocrine/metabolic disease as a result of intercurrent illness, emotional stress, or noncompliance with medications. The pediatric emergency medicine provider is faced with a difficult task when evaluating a child with a suspected endocrine or metabolic disorder, especially the child with no known underlying condition, since the signs and symptoms of such disorders are varied and nonspecific. This may lead to a delayed or missed diagnosis, and can have serious consequences (eg, cerebral dysfunction leading to coma or death as seen in diabetic ketoacidosis, hypoglycemia, or adrenal insufficiency). Prompt diagnosis depends on the collection of critical and archival laboratory specimens before the administration of nonspecific therapy.