Rheumatologic emergencies in newborns, children, and adolescents

Jonathan D Akikusa1

  • 1Rheumatology Service, Department of General Medicine, Royal Children's Hospital, 3 West Clinical Offices, 50 Flemington Road, Parkville, 3052, Victoria, Australia. Jonathan.akikusa@rch.org.au

Insights

Pediatric rheumatic diseases can present as life-threatening emergencies in children. This guide helps pediatricians recognize and manage these critical rheumatologic conditions in critically ill children.

Area of Science:

  • Pediatric Rheumatology
  • Emergency Medicine
  • Critical Care

Background:

  • Pediatric rheumatic diseases can present with severe, life-threatening manifestations.
  • Early recognition is crucial for timely intervention and improved outcomes.

Purpose of the Study:

  • To provide a problem-oriented guide for pediatricians.
  • To aid in recognizing rheumatologic differentials in critically ill children.
  • To outline initial investigation and management strategies.

Main Methods:

  • Presentation of five clinical scenarios.
  • Focus on initial manifestations of pediatric rheumatic diseases.
  • Problem-oriented approach for critical illness.

Main Results:

  • Highlights five clinical scenarios of pediatric rheumatic diseases presenting as emergencies.
  • Emphasizes the importance of considering rheumatologic causes in critical pediatric illness.
  • Offers guidance on initial diagnostic and management steps.

Conclusions:

  • Prompt recognition of pediatric rheumatic diseases in critical illness is vital.
  • This guide assists pediatricians in managing life-threatening rheumatologic emergencies.
  • A structured approach improves the care of critically ill children with rheumatic conditions.

Related Concept Videos

Rheumatic Heart Disease IV: Nursing Management01:20

Rheumatic Heart Disease IV: Nursing Management

AssessmentA comprehensive assessment is essential in managing a patient with rheumatic heart disease (RHD). Begin with obtaining a detailed medical history, including recent streptococcal infections, a history of rheumatic fever, or previously diagnosed rheumatic heart disease. Assess the patient for symptoms such as fever, chest pain, widespread joint pain (arthralgia), tachycardia, pericardial friction rub, muffled heart sounds, heart murmurs, peripheral edema, subcutaneous nodules, and...
Rheumatic Heart Disease III: Medical Management01:21

Rheumatic Heart Disease III: Medical Management

Rheumatic heart disease (RHD) management can be divided into two main strategies: prevention and long-term management.Primary PreventionPrimary prevention focuses on timely diagnosis and management of group A streptococcal pharyngitis to prevent acute rheumatic fever. The most widely used antibiotic for treating this condition is intramuscular benzathine penicillin G.Acute Rheumatic Fever TreatmentThe primary treatment goal for a patient diagnosed with acute rheumatic fever is to suppress the...
Pharmacokinetics in Pediatric Patients: Drug Excretion01:26

Pharmacokinetics in Pediatric Patients: Drug Excretion

In pediatric medicine, understanding the renal function and drug elimination nuances is crucial for administering safe and effective treatments. Newborns, in particular, display markedly slower renal functions than adults, profoundly affecting how drugs are cleared from their bodies. This slower drug clearance requires clinicians to extend the dosing intervals for many medications to prevent drug accumulation and toxicity while ensuring therapeutic efficacy.One key area where these adjustments...
Rheumatic Heart Disease I: Introduction01:23

Rheumatic Heart Disease I: Introduction

Rheumatic heart disease or RHD is a chronic condition that results from rheumatic fever, causing permanent damage to the heart valves.Etiology and Risk FactorsIt primarily arises from rheumatic fever, an inflammatory disease that can develop after untreated or inadequately treated group A streptococcal (GAS) pharyngitis. Streptococcus spreads through direct contact with oral or respiratory secretions. While the bacteria are the causative agents, factors like malnutrition, overcrowding, poor...
Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies01:22

Rheumatic Heart Disease II: Clinical Manifestations and Diagnostic Studies

The key clinical manifestations of Rheumatic heart disease (RHD) include several distinct cardiac symptoms.Carditis, a hallmark of acute rheumatic fever, involves inflammation of the heart's endocardium, myocardium, and pericardium. Chronic RHD often results from recurrent episodes of carditis. Its symptoms include the following:Murmurs are caused by valvular damage, especially to the mitral and aortic valves. Mitral stenosis or regurgitation is common, with characteristic heart murmurs...
Drug Dosing: Infants and Children01:29

Drug Dosing: Infants and Children

Pediatric patient dosages diverge from adults due to disparities in body surface area, total body water, and extracellular fluid per kilogram of body weight. The dosing regimen considers the variations in pharmacokinetics and pharmacology across distinct age groups, encompassing preterm newborns, infants, young children, older children, and adolescents. Calculation of pediatric patient doses is predicated on determining body surface area, which exhibits a superior correlation with the child's...