الفهرس 
Introduction
HypoglycemiaOnly 14 pages are availabe for public view
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Abstract
Diabetic ketoacidosis (DKA) is a life-threatening medical emergency that requires rapid yet judicious treatment. Pediatric patients in DKA warrant special attention with medical treatment because of their different presentations and susceptibility to the potentially fatal complication of cerebral edema. DKA is a serious complication of IDDM consisting of 3 major medical problems: hyperglycemia, elevated ketone bodies, and metabolic acidosis.Extreme hyperglycemia and hyperosmolality can occur without ketosis in patients who have diabetes (hyperglycemic hyperosmolar state [HHS]). This condition occurs much more frequently in adults than in children and more frequently in patients who have type 2 diabetes than in persons who have type 1 diabetes. It has been difficult to establish the prevalence of hypoglycemia in children with diabetes because of the application of different criteria to define hypoglycemia. It is important to deliver only the amount of glucose and calories sufficient to counteract an episode of hypoglycemia. The amount of glucose required varies with the degree of hypoglycemia. The blood glucose level should be checked after an episode of hypoglycemia to ensure the adequacy of treatment. Adrenal insufficiency, although rare in the general population, is an important clinical entity in pediatric critically ill patients with a variety of diagnoses. In order to maintain homeostasis during severe illness it is apparent that patients require adequate tissue corticosteroid concentrations. Cortisol is required to redirect available fuels to vital organs including brain and heart, preserve vascular tone and responsiveness to catecholamines and angiotensin, and modulate against the immune responses. The question then becomes how to treat those patients diagnosed with adrenal insufficiency. Unfortunately, pediatric studies of therapeutic intervention in patients with adrenal insufficiency are lacking. Hyponatremia (serum sodium <136 mmol/l) is the most common electrolyte abnormality. Hyponatremia was found in 30% of sick children attending one pediatric emergency service. It was associated with significantly higher mortality. A case has been made to use isotonic fluids, normal saline or Ringer’s lactate, as a maintenance fluid to prevent hospital acquired hyponatremia in critically ill children in acute phase of common childhood illnesses. Symptomatic hyponatremia is an emergency. Such patients should be treated in an intensive care unit, with infusion of hypertonic saline (3% saline). Hypernatremia can occur from either excessive intake of sodium or from excessive loss of free water relative to sodium. The management of hypernatremia should involve identification of the underlying cause and the duration of the hypernatremia. Treatment is directed at the underlying cause where one can be identified. This free water deficit is best corrected with oral or nasogastric free water over a period of 24 to 48 hours.