Cases in Pediatric Acute Care: Strengthening Clinical Decision Making [1 ed.] 1119568226, 9781119568223

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Cases in Pediatric Acute Care

Cases in Pediatric Acute Care Strengthening Clinical Decision Making

Edited by Andrea M. Kline-Tilford, PhD, CPNP-AC/PC, FCCM, FAAN C.S. Mott Children’s Hospital Michigan Medicine Ann Arbor, MI, USA

Catherine M. Haut, DNP, CPNP-AC/PC, FAANP, CCRN Nemours/Alfred I. duPont Hospital for Children Wilmington, DE, USA; Mednax Pediatrix Medical Group Baltimore, MD, USA

This edition first published 2020 © 2020 John Wiley & Sons Ltd All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at http://www.wiley.com/go/permissions. The right of Andrea M. Kline-Tilford and Catherine M. Haut to be identified as the author(s) of this work has been asserted in accordance with law. Registered Office(s) John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, USA John Wiley & Sons Ltd, The Atrium, Southern Gate, Chichester, West Sussex, PO19 8SQ, UK Editorial Office 9600 Garsington Road, Oxford, OX4 2DQ, UK For details of our global editorial offices, customer services, and more information about Wiley products visit us at www.wiley.com. Wiley also publishes its books in a variety of electronic formats and by print-on-demand. Some content that appears in standard print versions of this book may not be available in other formats. Limit of Liability/Disclaimer of Warranty The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting scientific method, diagnosis, or treatment by physicians for any particular patient. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of USAge and for added warnings and precautions. While the publisher and authors have used their best efforts in preparing this work, they make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives, written sales materials or promotional statements for this work. The fact that an organization, website, or product is referred to in this work as a citation and/or potential source of further information does not mean that the publisher and authors endorse the information or services the organization, website, or product may provide or recommendations it may make. This work is sold with the understanding that the publisher is not engaged in rendering professional services. The advice and strategies contained herein may not be suitable for your situation. You should consult with a specialist where appropriate. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages. Library of Congress Cataloging-in-Publication Data Library of Congress Cataloging-in-Publication Data Names: Kline-Tilford, Andrea M., editor. | Haut, Catherine, editor. Title: Cases in pediatric acute care : strengthening clinical decision making / edited by Andrea M. Kline-Tilford, Catherine Haut. Description: Hoboken, NJ : Wiley-Blackwell 2020. | Includes bibliographical references. Identifiers: LCCN 2019056731 (print) | LCCN 2019056732 (ebook) | ISBN 9781119568223 (paperback) | ISBN 9781119568209 (adobe pdf) | ISBN 9781119568216 (epub) Subjects: MESH: Critical Care–methods | Child | Critical Illness–diagnosis | Critical Illness–therapy | Diagnosis, Differential | Infant | Adolescent | Case Reports Classification: LCC RJ370 (print) | LCC RJ370 (ebook) | NLM WS 366 | DDC 618.92/0028–dc23 LC record available at https://lccn.loc.gov/2019056731 LC ebook record available at https://lccn.loc.gov/2019056732 Cover Design: Wiley Cover Images: Female doctor examining kid little child boy © Oksana Kuzmina/Shutterstock, Smiling doctor holding baby © JGI/Jamie Grill/ Getty Images, Pretty woman holding a newborn baby in her arms © Trendsetter Images/Shutterstock, Baby in mother’s arms in white blanket © Herlanzer/Shutterstock, Paediatrician checking baby boys heart using stethoscope © Emely/Getty Images Set in 9.5/12.5pt STIXTwoText by SPi Global, Pondicherry, India Printed and bound by CPI Group (UK) Ltd, Croydon, CR0 4YY 10 9 8 7 6 5 4 3 2 1

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Contents Preface xi List of Contributors

xiii

1

1

Complication of Pneumonia Ji-Yeon Kim

2

Infant with Diaphoresis during Feedings 5 Kristen Brown and Kristen Nelson McMillan

3

Hypotension in the Operating Room Ann Marie Felauer

7

4

Toddler with Vomiting and Diarrhea Kimberly L. DiMaria

11

5

Infant with Fever and Cold Symptoms Cheryl Bartke

6

Toddler with Pineoblastoma and Bone Marrow Transplant Cathryn Freeman

7

A 5-Year-Old with Altered Mental Status Yu-shan Tseng and Richard Garcia

8

An 8-Year-Old with Abdominal Trauma Julie Resler

9

Child with Left Eye Swelling Amy Graf

15

23 29

33

37

10

Billing and Coding Dawn M. Silverman

11

Language Delay Jolene Dickerson

12

A 6-Month-Old Infant with RSV and Respiratory Failure Catherine M. Haut

13

Adolescent Abdominal Pain after Cardiac Surgery Cathy Woodward

14

Young Infant with Vomiting Sarah Martin

15

School-age Child with Bruising 61 Lisa Hovingh and Candie Ritsema

16

Infant with Shunted Hydrocephalus Mark Weber

47

57

65

55

51

19

vi

Contents

69

17

Newborn with Poor Oral Intake and Irritability Elaine Geary

18

An 8-Week-Old Infant with a Cough Sarah Jane Garraty

19

Desaturation in Postoperative Cardiac Surgery Infant Lisa Kohr

20

Pre-school Child with Seizures 81 Heather Herrera and Rachel Luthen

21

Child with Blood in Stool 85 Brittany Cook and Darby Tozer

22

Osteomyelitis Case Study Kim Steanson

23

A 2-Year-Old with Liver Transplant and Fever Louise Flynn

24

Respiratory Decompensation in Trached Infant Jennifer Helman

25

Neonatal Hypoglycemia Janice L. Wilson

26

Chronic Otitis Media 105 Kimberly Young-Conner

27

Complex Patient with Recurrent Lower Respiratory Tract Infection Ann Marie Ramsey

28

Child with Racing Heart Bradley Goettl

29

Teen with Headache and Seizure Valarie Eichler

30

A 4-Year-Old with Bloody Diarrhea Tamara Hill

31

Child with Persistent Fever Misty Ellis

32

Quality Improvement Case Study Peggy Dorr

33

Newborn Immediately Post Delivery Heather Schniepp

34

A 5-Year-Old with Poor Weight Gain and Dehydration Kimberly Young-Conner

35

Toddler with Complex Chronic Condition Jennifer Wright

36

Pre-adolescent with Knee Pain 151 Katelyn Hamann and Shannon Konieczki

37

Infant with Increased Fussiness and Decreased Oral Intake Stephanie Haughey

38

Infant with Prolonged Jaundice Aimee Bucci

39

Child with Rash and Drooling Mark Weber

73 77

89 93 97

101

115 119 125

129 133

161 165

139 143

147

155

109

Contents

40

Child with Fever and Sore Throat 169 Stephanie Robell and Danielle Van Damme

41

Teenager with Sickle Cell Disease and Fever Shannon Konieczki and Katelyn Hamann

42

Ethical Case Study Jamie Tumulty

43

Infant with Neurologic Changes and Respiratory Failure Blythe Pollack and Stacey Sears

44

Acute Hyperglycemia Jeanne Little

45

Infant with Progressive Lethargy and Poor Feeding Kathleen P. Thompson

46

Neonatal Tachypnea Janet Dutcher

47

Diplopia and Esotropia Lindsay Chapman

48

Acetaminophen Ingestion Aaron Carpenter

49

A 3-Year-Old with Sudden Onset of Breathing Difficulty Judy Verger

50

A 2-Month-Old with Acute Abdomen Christyne Kyper

215

51

Henoch–Schönlein Purpura Nephritis Tamara Hill

219

52

Toddler with Tachypnea and Cool Extremities Cathy Woodward

53

Teen with Intractable Headache Tara Pezzuto

54

Seizures in School-age Child 231 Ann Marie Felauer

55

An 18-Year-Old with Upper Respiratory Symptoms, Headache and Fever Misty Evans

56

Testicular Torsion Amanda Mandel

57

Teen with Fever and Rash 243 Christine Renke and Elizabeth Hoppe

58

Preterm Infant Unable to Wean from Mechanical Ventilation Michelle Dokas

59

Toddler with Acute Respiratory Failure Ahmed Aly and Bradley Tilford

60

Adolescent with Head Injury Jennette Firlein

61

Newborn with Ambiguous Genitalia Barbara Wise

62

Anemia in a Toddler Dyane Bunnell

173

177 183

191 195

199 203 207 211

223

227

239

265

251

255 261

247

235

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Contents

269

63

A 2-Year-Old with Fever and Cough Jessica Strohm Farber

64

Research Review Lauren R. Sorce

65

Toddler with Fever and Redness Behind Ear Amanda Lewis Weir

66

A 5-Year-Old with Right-Sided Weakness Suzette Meinke and Jessica Spruit

67

Postoperative Heart Block Cathy Woodward

68

Recognizing Human Trafficking Christine DiPaolo

69

A Toddler With Stridor Mari Welch

70

Delirium in a 9-Year-Old Boy Heather Herrera

71

Feeding Challenge in a Child with Spinal Muscular Atrophy Nicole Fragale

72

A 5-Year-Old with Osteomyelitis, Electrolyte Disturbance and Headaches Kimberly L. DiMaria

73

Child with Scald Burn Injury 307 Amarilis Martin and Bradley Tilford

74

Parvovirus Requiring Blood Transfusion Ashley Thibodeau

75

A Teen With High Fever, Rash and Lethargy Jessica Strohm Farber

76

A 9-Year-Old With Scoliosis Alicia McCarthy

77

An Unresponsive Infant Charlene Pringle

78

A Toddler With Abdominal Pain, Diarrhea and Lethargy Jessica Pech

79

Sore Throat and Shortness of Breath Amy Manion

80

Oral Presentation and Communication Jill Siegrist Thomas

81

A 7-Year-Old with Migratory Joint Pain Christin Diller

82

Adolescent with Murmur and Chest Flutter Natalie Hecht

83

Outpatient Management of Asthma Jolene Dickerson

84

A Newborn with Abnormal Movements Maura Bernardo

85

Postoperative Infant with Tachycardia Cathy Woodward

273 277

281

285 287

291 295

313 317

321

325

335 339 345

353 357 361

349

331

299 303

Contents

86

Brain Death 363 Maria C. Woosley

87

Postoperative Spinal Fusion with Complications Jaime Panton and Melissa C. Varrone

88

Orthopnea in a 10-Year-Old Max Pizzo

89

Complication of Traumatic Brain Injury Christine Schindler

90

Newborn with Hypothermia Marshay James

91

Back Pain in an Active Teenager Alicia McCarthy

92

Teen with Fever and Abdominal Pain Sarah Martin

93

Complication in a 6-Year-Old with a Kidney Transplant Alison Hewitt Torres

94

Acute Hypertension and Seizures in a 17-Year-Old Male Alison Hewitt Torres

95

Jittery 2-Week-Old Infant Christopher D. Newman

96

Child with Leg and Back Pain Jill Marks

97

Fussy, Tired Infant Charlene Pringle

98

Tics and Something More Judy Adelizzi-DeLany

99

Lightheaded Adolescent Cathy Woodward

367

371 375

379 383 387

399 403

407 411 415 419

100

Infant with Hyponatremia Sarah Pihl

101

Bone Marrow Transplant in Sickle Cell Disease J. Paige Rieckhoff

102

Child with Respiratory Failure and Transaminitis Kim Steanson

103

A Serious Football Injury Julie Resler

104

Infant with Generalized Weakness Blythe Pollack

105

A 3-Day-Old with Irritability Christopher D. Newman

106

Child with Fever and Rash Misty Evans

107

A Teen With Vomiting and Diarrhea Christyne Kyper

108

Acute Jaundice in a 7-Year-Old Child Roseann Hausmann

431 435

441 445 449 453

423 427

391 395

ix

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Contents

109

Idiopathic Nephrotic Syndrome 457 Tamara Hill

110

School-age Child with Hives and Lip Swelling Jay M. Hunter

111

A 10-Year-Old with Asthma in the PICU Catherine M. Haut

112

Skin Wound in Postoperative Neonate Hayley Redmond

113

Provider Burnout and Resiliency Jill Siegrist Thomas

471

114

Kidney Transplant Complication Cathy C. McAdams

475

115

Infant with Influenza A and New Fever Lauren Flagg

116

A 3-Year-Old with Fever and Painful Urination Roseann Hausmann Index

487

461

463 467

479 483

xi

Preface The healthcare landscape is rapidly changing and will continue to evolve, providing challenges for patients and families, but also for those providing care. Preventative care for children forms the framework for minimizing hospitalization, injury and illness, but when children do become ill, providing care with the goal of a quick return to function and home must be collaborative and timely. Children are basically healthy and the incidence of illness and injury is small as compared to adults, but the challenges of diagnosis and management can be dramatic. Children bring unique and unusual genetic problems, chronic healthcare issues, trauma, and acute and critical presentations to inpatient and outpatient areas. It is especially important for pediatric providers to recognize diagnoses and potential clinical outcomes in the first few

minutes of their encounters with these children and their families. It is also imperative for pediatric providers to engage the most recent evidence-based practice parameters to substantiate care while incorporating the unique needs of the child and utilizing critical thinking for decision-making. In this book, pediatric cases are presented with an opportunity for the reader to answer questions about assessment, diagnosis and management, interpret diagnostic studies as well as to incorporate practical considerations such as billing for services and participating in research at the point of care. System-based, contemporary, common as well as unusual clinical cases are included that will challenge the reader and add knowledge. We thank the contributors for sharing their patient stories and expertise in creating this book.

xiii

List of Contributors Judith Adelizzi-DeLany, DNP, PPCNP-BC Nurse Practitioner Nemours/Alfred I. duPont Hospital for Children Wilmington, DE USA Chapter 98 Tics and Something More

Kristen M. Brown, DNP, CPNP-AC, CHSE-A Assistant Professor Advanced Practice Simulation Coordinator John Hopkins University School of Nursing Baltimore, MD USA Chapter 2 Infant with Diaphoresis during Feedings

Sheree H. Allen, DNP, APRN, CPNP-PC/AC Director, Pediatric Acute Care Nurse Practitioner Specialty Vanderbilt University School of Nursing Nashville, TN USA Section Editor: Infectious Disease

Aimee Bucci, DNP, CPNP-AC Lead Advanced Practice Provider Phoenix Children’s Hospital Phoenix, AZ; Faculty Associate Arizona State University Edson College of Nursing and Health Innovation Phoenix, AZ USA Chapter 38 Infant with Prolonged Jaundice

Ahmed Aly, MD Pediatric Critical Care Fellow Children’s Hospital of Michigan Detroit, MI USA Chapter 59 Toddler with Acute Respiratory Failure

Cheryl Bartke, MSN, PPCNP, CPNP-AC Nurse Practitioner Pediatric Critical Care Seattle Children’s Hospital Seattle, WA USA Chapter 5 Infant with Fever and Cold Symptoms

Maura Bernardo, MSN, CPNP Nurse Practitioner Nemours/Alfred I. duPont Hospital for Children Wilmington, DE USA Chapter 84 A Newborn with Abnormal Movements

Dyane Bunnell, MSN, APRN-BC, AOCNS, CPON Clinical Nurse Specialist Nemours/Alfred I. duPont Hospital for Children Wilmington, DE USA Chapter 62 Anemia in a Toddler Aaron Carpenter, DNP, M.Div., CPNP-PC Senior Director Ambulatory and Advanced Practice Nursing Nemours/Alfred I. duPont Hospital for Children Wilmington, DE USA Chapter 48 Acetaminophen Ingestion Lindsay Chapman, MSN, CPNP-PC Nurse Practitioner St. Jude Children’s Research Hospital Memphis, TN USA Chapter 47 Diplopia and Esotropia

xiv

List of Contributors

Brittany Cook, MSN, FNP-BC Nurse Practitioner Pediatric Emergency Medicine Beaumont Hospital Troy, MI USA Chapter 21 Child with Blood in Stool Jolene Dickerson, MSN, CPNP-PC Nurse Practitioner Nemours/Alfred I. duPont Hospital for Children Wilmington, DE USA Chapter 11 Language Delay; Chapter 83 Outpatient Management of Asthma Christin Diller, DNP, CPNP-AC Nurse Practitioner Cincinnati Children’s Hospital Medical Center Cincinnati, OH; Nursing Instructor Vanderbilt University College of Nursing Nashville, TN USA Chapter 81 A 7-Year-Old with Migratory Joint Pain Colleen Ditro, DNP, CPNP Orthopedic APRN Supervisor, Skeletal Dysplasia Program Coordinator Nemours/Alfred I. duPont Hospital for Children Wilmington, DE USA Section Editor: Trauma, Musculoskeletal, Toxicology Kimberly L. DiMaria, MSN, CPNP-AC, CCRN Heart Institute Clinical Practice Specialist Children’s Hospital Colorado Aurora, CO USA Chapter 4 Toddler with Vomiting and Diarrhea; Chapter 72 A 5-Year-Old with Osteomyelitis, Electrolyte Disturbance and Headaches Christine DiPaolo, NP Nurse Practitioner Nemours/Alfred I. duPont Hospital for Children Wilmington, DE USA Chapter 68 Recognizing Human Trafficking

Michelle Dokas, MSN, CPNP-AC Nurse Practitioner Pediatric Cardiovascular Surgery Children’s Hospital of Michigan Detroit, MI USA Chapter 58 Preterm Infant Unable to Wean from Mechanical Ventilation

Peggy Dorr, DNP, CPNP-PCNP Clinical Program Manager, Women & Children’s Services Nurse Practitioner, Pediatric Sedation Service University of Maryland Medical Center Baltimore, MD USA Chapter 32 Quality Improvement Case Study

Janet Dutcher, DNP, NNP, APRN-BC Neonatal Nurse Practitioner Nemours/Alfred I. duPont Hospital for Children Wilmington, DE USA Chapter 46 Neonatal Tachypnea

Valarie Eichler, MSN, CPNP-AC Nurse Practitioner Dallas Children’s Hospital Dallas, TX USA Chapter 29 Teen with Headache and Seizure Misty Ellis, DNP, CPNP-AC/PC Lead Cardiac Nurse Practitioner Norton Children’s Hospital Louisville, KY USA Chapter 31 Child with Persistent Fever

Misty Evans, DNP, CPNP-AC Nurse Practitioner Vanderbilt College of Nursing Nashville, TN USA Chapter 55 An 18-Year-Old with Upper Respiratory Symptoms, Headache and Fever; Chapter 106 Child with Fever and Rash

List of Contributors

Jessica Strohm Farber, DNP, CPNP-AC Nurse Practitioner Children’s Hospital of Philadelphia Philadelphia, PA USA Chapter 63 A 2-Year-Old with Fever and Cough; Chapter 75 A Teen With High Fever, Rash and Lethargy Ann Marie Felauer, DNP, CPNP-AC/PC Assistant Professor and Director Pediatric Acute and Primary Care Nurse Practitioner Specialties UMB CURE Anatomy and Chemistry Curriculum Tracks, Program Manager University of Maryland School of Nursing Baltimore, MD USA Chapter 3 Hypotension in the Operating Room; Chapter 54 Seizures in School-age Child Section Editor: Endocrinology Jennette Firlein, MSN, CPNP-PC Nurse Practitioner Nemours/Alfred I. duPont Hospital for Children Wilmington, DE USA Chapter 60 Adolescent with Head Injury Lauren Flagg, MSN, CPNP-AC Nurse Practitioner Yale New Haven Hospital New Haven, CT USA Chapter 115 Infant with Influenza A and New Fever

Cathryn Freeman, MSN, CPNP-PC Nurse Practitioner Pediatric Hematology/Oncology Children’s Hospital of Michigan Detroit, MI USA Chapter 6 Toddler with Pineoblastoma and Bone Marrow Transplant

Richard U. Garcia, MD Assistant Professor Department of Pediatrics Division of Cardiology and Critical Care Wayne State University Detroit, MI USA Chapter 7 A 5-Year-Old with Altered Mental Status

Sarah Jane Garraty, MSN, CPNP Nurse Practitioner Beacon Pediatrics Rehoboth Beach, DE USA Chapter 18 An 8-Week-Old Infant with a Cough

Elaine Geary, MSN, CRNP Nurse Practitioner Nemours/Alfred I. duPont Hospital for Children Wilmington, DE USA Chapter 17 Newborn with Poor Oral Intake and Irritability

Louise Flynn, MSN, CCTC Clinical Nurse Specialist Nemours/Alfred I. duPont Hospital for Children Wilmingon, DE USA Chapter 23 A 2-Year-Old with Liver Transplant and Fever

Bradley Goettl, DNP, AGACNP-BC, FNP-C, ENP-C Assistant Professor/Clinical University of Texas Health San Antonio, TX USA Chapter 28 Child with Racing Heart

Nicole Fragale, MPH, RD, CSP, LDN, CNSC Registered Dietitian Nemours/Alfred I. duPont Hospital for Children Wilmington, DE USA Chapter 71 Feeding Challenge in a Child with Spinal Muscular Atrophy

Amy K. Graf, MSN, DNP, FNP-C, CPNP-AC Nurse Practitioner Norton Women and Children’s Hospital Louisville, KY USA Chapter 9 Child with Left Eye Swelling

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List of Contributors

Katelyn Hamann, MSN, CPNP-AC Nurse Practitioner Pediatric Hematology/Oncology Children’s Hospital of Michigan Detroit, MI USA Chapter 36 Pre-adolescent with Knee Pain; Chapter 41 Teenager with Sickle Cell Disease and Fever Stephanie Haughey, MSN, CPNP-AC Nurse Practitioner Spectrum Health, Helen DeVos Children’s Hospital Grand Rapids, MI USA Chapter 37 Infant with Increased Fussiness and Decreased Oral Intake Roseann Hausmann, MSN, CPNP-AC/PC Nurse Practitioner Seattle Children’s Hospital Seattle, WA USA Chapter 108 Acute Jaundice in a 7-Year-Old Child; Chapter 116 A 3-Year-Old with Fever and Painful Urination Catherine M. Haut, DNP, CPNP-AC/PC, FAANP, CCRN Coordinator of Nursing Research and Evidence Based Care Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE; Nurse Practitioner Mednax-Pediatrix Medical Group Richardson, TX USA Chapter 12 A 6-Month-Old Infant with RSV and Respiratory Failure; Chapter 111 A 10-Year-Old with Asthma in the PICU Section Editor: Respiratory Book Editor: Cases in Pediatric Acute Care: Strengthening Clinical Decision Making Natalie Hecht, MSN, CPNP-AC Nurse Practitioner Pediatric Cardiac Surgery C.S. Mott Children’s Hospital Ann Arbor, MI USA Chapter 82 Adolescent with Murmur and Chest Flutter Jennifer Helman, MSN, CPNP-AC/PC Nurse Practitioner Pediatric Otolaryngology C.S. Mott Children’s Hospital Ann Arbor, MI USA Chapter 24 Respiratory Decompensation in Trached Infant

Heather Herrera, MSN, CPNP-AC/PC Nurse Practitioner Children’s Hospital of San Antonio San Antonio, TX USA Chapter 20 Pre-school Child with Seizures; Chapter 70 Delirium in a 9-Year-Old Boy Tamara Hill, DNP, CPNP-AC Nurse Practitioner UMSON Faculty Associate/Adjunct Faculty University of Maryland Medical Center Baltimore, MD USA Chapter 30 A 4-Year-Old with Bloody Diarrhea; Chapter 51 Henoch–Schönlein Purpura Nephritis; Chapter 109 Idiopathic Nephrotic Syndrome Section Editor: Genitourinary/Renal Elizabeth Hoppe, MSN, CPNP-AC Nurse Practitioner Ann & Robert H. Lurie Children’s Hospital of Chicago Chicago, IL USA Chapter 57 Teen with Fever and Rash Lisa Hovingh, CPNP-AC Nurse Practitioner Pediatric Hematology/Oncology Helen DeVos Children’s Hospital Grand Rapids, MI USA Chapter 15 School-age Child with Bruising Jay M. Hunter, DNP, CPNP-AC, CCRN, CPN Nurse Practitioner and Assistant Clinical Professor UCSF Benioff Children’s Hospital and UCSF School of Nursing San Francisco, CA USA Chapter 110 School-age Child with Hives and Lip Swelling Marshay James, DNP, MSNEd, CPNP-AC, CPEN, CNE Instructor Vanderbilt University School of Nursing Nashville, TN; Advanced Practice Provider Manager Department of Critical Care Medicine St. Jude Children’s Research Hospital Memphis, TN USA Chapter 90 Newborn with Hypothermia

List of Contributors

Jennifer Joiner, MSN, CPNP-AC/PC Assistant Professor Baylor College of Medicine Lead Nurse Practitioner Pediatric Intensive Care Unit Children’s Hospital of San Antonio San Antonio, TX USA Section Editor: Neurology

Jeanne Little, DNP, PNP-AC/PC Assistant Professor Rush University College of Nursing Chicago, IL USA Chapter 44 Acute Hyperglycemia

Ji-Yeon Kim, MD Pediatric Critical Care Children’s Hospital of Michigan Detroit, MI USA Chapter 1 Complication of Pneumonia

Rachel Luthen, MSN, CPNP-AC Nurse Practitioner Children’s Hospital of San Antonio San Antonio, TX USA Chapter 20 Pre-school Child with Seizures

Andrea M. Kline-Tilford, PhD, CPNP-AC/PC, FCCM, FAAN Nurse Practitioner Manager C.S. Mott Children’s Hospital Michigan Medicine Ann Arbor, MI USA Book Editor: Cases in Pediatric Acute Care: Strengthening Clinical Decision Making

Amanda Mandel, CPNP Urology Nurse Practitioner Nemours/Alfred I. duPont Hospital for Children Wilmington, DE USA Chapter 56 Testicular Torsion

Lisa M. Kohr, MSN, CPNP-AC, MPH Nurse Practitioner Acute Care Cardiology Cincinnati Children’s Hospital Medical Center Cincinnati, OH USA Chapter 19 Desaturation in Postoperative Cardiac Surgery Infant

Amy Manion, PhD, RN, CPNP-PC Nurse Practitioner Associate Professor Rush University College of Nursing Chicago, IL USA Chapter 79 Sore Throat and Shortness of Breath

Shannon Konieczki, MSN, CPNP-AC Nurse Practitioner Children’s Hospital of Michigan Detroit, MI USA Chapter 36 Pre-adolescent with Knee Pain; Chapter 41 Teenager with Sickle Cell Disease and Fever

Jill Marks, DNP, CPNP-AC Senior Instructor University of Colorado Pediatric Neurology, Boulder, CO; Faculty Acute Care Pediatric Nurse Practitioner Program Rush University College of Nursing Chicago, IL USA Chapter 96 Child with Leg and Back Pain

Christyne Kyper, MSN, CPNP AC/PC Nurse Practitioner Alaska Native Tribal Health Consortium Anchorage, AK USA Chapter 50 A 2-Month-Old with Acute Abdomen; Chapter 107 A Teen With Vomiting and Diarrhea

Amarilis Martin, MD Pediatric Critical Care Fellow Children’s Hospital of Michigan Detroit, MI USA Chapter 73 Child with Scald Burn Injury

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List of Contributors

Sarah Martin, MS, CPNP-AC/PC, CCRN Nurse Practitioner Department of Pediatric Surgery Ann & Robert H. Lurie Children’s Hospital Chicago, IL USA Chapter 14 Young Infant with Vomiting; Chapter 92 Teen with Fever and Abdominal Pain

Osei Owusu, MD Pediatric Critical Care Medicine Mednax-Pediatrix Medical Group The Herman and Walter Samuelson Children’s Hospital Baltimore, MD USA Section Editor: Respiratory

Cathy C. McAdams, PPCNP-BC Nurse Practitioner Nemours/Alfred I. duPont Hospital for Children Wilmington, DE USA Chapter 114 Kidney Transplant Complication

Jaime Panton, DNP, CPNP-AC/PC Assistant Professor of Nursing PNP Program Director Columbia School of Nursing New York, NY USA Chapter 87 Postoperative Spinal Fusion with Complications

Alicia McCarthy, MSN, CPNP-AC Nurse Practitioner Nemours/Alfred I. duPont Hospital for Children Wilmington, DE USA Chapter 76 A 9-Year-Old With Scoliosis; Chapter 91 Back Pain in an Active Teenager Kristen Nelson McMillan, MD Associate Professor Pediatric Cardiac Critical Care Advocate Children’s Pediatric Heart Institute University of Chicago Comer Children’s Hospital Chicago, IL USA Chapter 2 Infant with Diaphoresis during Feedings

Jessica Pech, MSN, CPNP-PC Nurse Practitioner Ann & Robert H. Lurie Children’s Hospital of Chicago Chicago, IL USA Chapter 78 A Toddler With Abdominal Pain, Diarrhea and Lethargy

Tara Pezzuto, DNP, CPNP Headache Program Nemours/Alfred I. duPont Hospital for Children Wilmington, DE USA Chapter 53 Teen with Intractable Headache

Suzette Meinke, MSN, PNP-BC Nurse Practitioner Pediatric Hematology Children’s Hospital of Michigan Detroit, MI USA Chapter 66 A 5-Year-Old with Right-Sided Weakness

Sarah Pihl, MSN, CPNP-AC Nurse Practitioner and Senior Instructor Children’s Hospital of Colorado Aurora, CO USA Chapter 100 Infant with Hyponatremia

Christopher D. Newman, PA-C, FCCM Physician Assistant Children’s Hospital of Colorado Aurora, CO USA Chapter 95 Jittery 2-Week-Old Infant; Chapter 105 A 3-Day-Old with Irritability; Section Editor: Fluid and Electrolytes

Max Pizzo, MS, CPNP-AC Nurse Practitioner Pediatric Critical Care Medicine C.S. Mott Children’s Hospital Ann Arbor, MI USA Chapter 88 Orthopnea in a 10-Year-Old

List of Contributors

Blythe Pollack, MSN, CPNP-AC Nurse Practitioner Pediatric Critical Care Medicine C.S. Mott Children’s Hospital Ann Arbor, MI USA Chapter 43 Infant with Neurologic Changes and Respiratory Failure; Chapter 104 Infant with Generalized Weakness Charlene Pringle, MSN, CPNP-AC/PC Nurse Practitioner Pediatric Critical Care Medicine University of Florida Gainesville, FL USA Chapter 77 An Unresponsive Infant; Chapter 97 Fussy, Tired Infant Ann Marie Ramsey, RN, MSN, CPNP Pediatric Nurse Practitioner Pediatric Home Ventilator Program C.S. Mott Children’s Hospital Michigan Medicine Ann Arbor, MI USA Chapter 27 Complex Patient with Recurrent Lower Respiratory Tract Infection Hayley Redmond, DO, FAAP Pediatric Critical Care Fellow Norton Children’s Hospital Louisville, KY USA Chapter 112 Skin Wound in Postoperative Neonate Christine Renke, MSN, CPNP-AC Nurse Practitioner Pediatric Critical Care Medicine C.S. Mott Children’s Hospital Ann Arbor, MI USA Chapter 57 Teen with Fever and Rash Julie Resler, CPNP-AC Nurse Practitioner Riley Hospital for Children Indianapolis, IN USA Chapter 8 An 8-Year-Old with Abdominal Trauma; Chapter 103 A Serious Football Injury

J. Paige Rieckhoff, MSN, CPNP-AC Nurse Practitioner C.S. Mott Children’s Hospital Ann Arbor, MI USA Chapter 101 Bone Marrow Transplant in Sickle Cell Disease Candie Ritsema, MSN, CPNP-AC, CPON Nurse Practitioner Pediatric Hematology/Oncology Helen DeVos Children’s Hospital Grand Rapids, MI USA Chapter 15 School-age Child with Bruising Stephanie Robell, MSN, CPNP-AC Nurse Practitioner Pediatric Critical Care Medicine C.S. Mott Children’s Hospital Ann Arbor, MI USA Chapter 40 Child with Fever and Sore Throat Christine Schindler, PhD, RN, CPNP-PC/AC Clinical Associate Professor Coordinator Pediatric Acute Care Graduate Option Marquette University College of Nursing Milwaukee, WI; Advanced Practice Provider Director Critical Care/Palliative Care Advanced Practice Provider Program Medical College of WI/Children’s Hospital of WI Milwaukee, WI USA Chapter 89 Complication of Traumatic Brain Injury Heather Schniepp, DNP, CPNP-AC/PC Nurse Practitioner University of Texas Health San Antonio, TX USA Chapter 33 Newborn Immediately Post Delivery Stacey Sears, MSN, CPNP-AC Nurse Practitioner Pediatric Critical Care Medicine C.S. Mott Children’s Hospital Ann Arbor, MI USA Chapter 43 Infant with Neurologic Changes and Respiratory Failure

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List of Contributors

Danielle Sebbens, DNP, CPNP-AC/PC Clinical Associate Professor Coordinator Acute Care Pediatric Nurse Practitioner Program Arizona State University Edson College of Nursing and Health Innovation Phoenix, AZ; Alaska Native Medical Center Nurse Practitioner Anchorage, AK USA Section Editor: Gastrointestinal Shari Simone, DNP, CPNP-AC, FAANP, FCCM, FAAN Senior NP Clinical Program Manager Women & Children’s Services Nurse Practitioner University of Maryland Medical Center Baltimore, MD USA Section Editor: Professional Issues Dawn M. Silverman, DNP, CRNP, AGACNP-BC Nurse Practitioner University of Maryland Children’s Hospital University of Maryland Medical Center Baltimore, MD USA Chapter 10 Billing and Coding

Kim Steanson, DNP, CPNP-AC/PC Nurse Practitioner Monroe Carell Jr. Children’s Hospital at Vanderbilt Nashville, TN; Instructor Vanderbilt University School of Nursing Nashville, TN USA Chapter 22 Osteomyelitis Case Study; Chapter 102 Child with Respiratory Failure and Transaminitis

Ashley Thibodeau, DNP, CPNP-PC Nurse Practitioner Seattle Children’s Hospital Seattle, WA USA Chapter 74 Parvovirus Requiring Blood Transfusion

Jill Siegrist Thomas, MSN, CPNP-AC Nurse Practitioner University of Maryland Children’s Hospital University of Maryland Medical Center Baltimore, MD USA Chapter 80 Oral Presentation and Communication; Chapter 113 Provider Burnout and Resiliency

Lauren R. Sorce, PhD, CPNP-AC/PC, CCRN, FCCM Founders Board Nurse Scientist Pediatric Critical Care APRN Ann & Robert H. Lurie Children’s Hospital of Chicago Chicago, IL; Assistant Professor, Division of Critical Care Medicine Northwestern University Feinberg School of Medicine Chicago, IL USA Chapter 64 Research Review

Kathleen P. Thompson, MPAS, PA-C Assistant Professor Baylor College of Medicine, Houston, TX; Physician Assistant Program & Department of Pediatrics Pediatric Critical Care Medicine, Texas Children’s Hospital Houston, TX USA Chapter 45 Infant with Progressive Lethargy and Poor Feeding

Jessica Spruit, DNP, CPNP-AC, CPHON, BMTCN Assistant Professor, Clinical Wayne State University College of Nursing Detroit, MI USA Chapter 66 A 5-Year-Old with Right-Sided Weakness Section Editor: Hematology/Oncology

Bradley Tilford, MD Pediatric Intensivist Children’s Hospital of Michigan Detroit, MI USA Chapter 59 Toddler with Acute Respiratory Failure; Chapter 73 Child with Scald Burn Injury

List of Contributors

Alison Hewitt Torres, MSN, CPNP-AC Nurse Practitioner Johns Hopkins Children’s Center Baltimore, MD USA Chapter 93 Complication in a 6-Year-Old with a Kidney Transplant; Chapter 94 Acute Hypertension and Seizures in a 17-Year-Old Male Darby Tozer, MSN, CPNP-AC Nurse Practitioner Pediatric Emergency Medicine Beaumont Hospital Troy, MI USA Chapter 21 Child with Blood in Stool Yu-shan Tseng, MD Pediatric Critical Care Fellow Children’s Hospital of Michigan Detroit, MI USA Chapter 7 A 5-Year-Old with Altered Mental Status Jamie Tumulty, MSN, CPNP-AC Nurse Practitioner University of Maryland Children’s Hospital University of Maryland Medical Center Baltimore, MD USA Chapter 42 Ethical Case Study Danielle Van Damme, DNP, CPNP-AC Nurse Practitioner Norton Children’s Hospital University of Louisville Louisville, KY USA Chapter 40 Child with Fever and Sore Throat Section Editor: Immunology/Rheumatology/HEENT/ Dermatology Melissa C. Varrone, MSN, CPNP, CCRN Pediatric Orthopedic Nurse Practitioner Morgan Stanley Children’s Hospital of New York, NY; New York Presbyterian Hospital, Columbia University Irving Medical Center New York, NY USA Chapter 87 Postoperative Spinal Fusion with Complications

Judy Verger, ARNP, PhD, FAAN, FCCM University of Iowa School of Nursing Iowa City, IA USA Chapter 49 A 3-Year-Old with Sudden Onset of Breathing Difficulty Mark Weber, CPNP-AC, FCCM Nurse Practitioner Children’s Hospital of Philadelphia Philadelphia, PA USA Chapter 16 Infant with Shunted Hydrocephalus; Chapter 39 Child with Rash and Drooling Amanda Lewis Weir, CPNP-AC Nurse Practitioner Norton Children’s Hospital Louisville, KY USA Chapter 65 Toddler with Fever and Redness Behind Ear Mari Welch, MSN, APRN, CPNP-AC Nurse Practitioner Nemours/Alfred I. duPont Hospital for Children Wilmington, DE USA Chapter 69 A Toddler With Stridor Janice L. Wilson, DNP, NNP-BC Assistant Professor and NNP Specialty Director University of Maryland School of Nursing Baltimore, MD USA Chapter 25 Neonatal Hypoglycemia Barbara Wise, PhD, CPNP-AC/PC Assistant Professor University of Maryland School of Nursing Baltimore, MD USA Chapter 61 Newborn with Ambiguous Genitalia Cathy Woodward, DNP, APRN, CPNP-AC Professor Long School of Medicine University of Texas Health San Antonio, TX USA Chapter 13 Adolescent Abdominal Pain after Cardiac Surgery; Chapter 52 Toddler with Tachypnea and Cool Extremities; Chapter 67 Postoperative Heart Block; Chapter 85 Postoperative Infant with Tachycardia; Chapter 99 Lightheaded Adolescent Section Editor: Cardiovascular

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List of Contributors

Maria C. Woosley, DNP, CPNP-AC Faculty Clinical Instructor Long School of Medicine University of Texas Health San Antonio, TX USA Chapter 86 Brain Death Jennifer Wright, MS, RN, CPNP-PC Nurse Practitioner Stepping Stones Pediatric Palliative Care C.S. Mott Children’s Hospital Ann Arbor, MI USA Chapter 35 Toddler with Complex Chronic Condition

Kimberly Young-Conner, ARNP-C Nurse Practitioner Nemours/Alfred I. duPont Hospital for Children Wilmington, DE USA Chapter 26 Chronic Otitis Media; Chapter 34 A 5-Year-Old with Poor Weight Gain and Dehydration

1

1 Complication of Pneumonia Ji-Yeon Kim Children’s Hospital of Michigan, Detroit, MI, USA

A 2-year-old previously healthy female is admitted to the pediatric intensive care unit (PICU) with tachypnea, grunting, and nasal flaring. She is hypoxic despite receiving supplemental oxygen with a high-flow nasal cannula (HFNC) at 12 L/min and FiO2 0.7.

Family History Parents are healthy. There is a 6-year-old sibling who had a cold and fever about a week ago. Grandparents are alive and well. Paternal grandmother has a history of breast cancer. Denies family history of asthma or allergies.

History of Present Illness This is a 2-year-old female with no significant past medical history who presented with 2 days of fever, cough, and difficulty breathing. Her mother reports that for the past 2 weeks the patient has had intermittent low-grade fever with cough. Difficulty breathing started 2 days ago with fever of 40 C (104 F). She has been eating and drinking less and having decreased wet diapers. She has been in close contact with her older brother who has also had symptoms of cough, rhinorrhea, and congestion. Her parents decided to bring her to the emergency department (ED) when her fever did not defervesce with acetaminophen and she continued to have difficulty breathing.

Current Status On arrival in the ED, the patient is noted to have difficulty breathing, with grunting and nasal flaring. She is tachycardic, with heart rate of 160 bpm, and tachypneic, with respiratory rate of 56 breaths per minute. On examination the patient has diminished breath sounds over the left lung field. The patient is placed on 50% oxygen using HFNC at 8 L/min but remains hypoxic with pulse oximeter reading of 90% saturation. A basic metabolic panel and complete blood count are obtained with values as noted in Tables 1.1 and 1.2. The chest X-ray is shown in Figure 1.1.

Past Medical History The patient was born at 39 weeks gestational age. Family denies history of hospitalizations or outpatient visits for illness. Immunizations are up-to-date for age, but she has not received the influenza vaccine this year.

Questions Answer the following questions using the details provided. 1 2

Past Surgical History 3 Family denies any previous surgical procedures.

What are the pathologic findings on the X-ray? What are the most common pathogens causing pneumonia in infants and children? What are the recommended antimicrobial therapies for bacterial pneumonia?

Cases in Pediatric Acute Care: Strengthening Clinical Decision Making, First Edition. Edited by Andrea M. Kline-Tilford and Catherine M. Haut. © 2020 John Wiley & Sons Ltd. Published 2020 by John Wiley & Sons Ltd.

2

Cases in Pediatric Acute Care

Table 1.1 Complete blood count. White blood cell count

18 900/mm3

Hemoglobin

13 g/dL

Hematocrit

32%

Platelet count

303 000/mm3

Neutrophils

63%

Lymphocytes

11%

Monocytes

20%

Bands

4%

Table 1.2 Basic metabolic profile. Sodium

130 mEq/L

Potassium

4.5 mEq/L

Chloride

97 mEq/L

Carbon dioxide

18 mEq/L

Blood urea nitrogen

35 mg/dL

Creatinine

0.83 mg/dL

Glucose

135 mg/dL

C-reactive protein (CRP)

4412 mg/L

There is complete obliteration of the lateral hemithorax and the left lung base. The right lung is clear. Gas-distended bowel loops are noted in the left upper abdomen.

What are the most common pathogens causing pneumonia in infants and children? See Table 1.3.

What are the recommended antimicrobial therapies for bacterial pneumonia? Treatment of suspected bacterial pneumonia is based on presumed pathogen, age, and clinical appearance of the patient. For a mildly ill child who does not require hospitalization, amoxicillin is recommended. For school-age children or clinical features concerning for atypical pneumonia (Mycoplasma pneumoniae or Chlamydophila pneumoniae), azithromycin is recommended. For those who require hospitalization, the antibiotic of choice is cefotaxime or ceftriaxone. If clinical features suggest Staphylococcus aureus (pneumatoceles, empyema or bronchopulmonary fistula) initial antibiotic therapy should include clindamycin or vancomycin. If viral pneumonia is suspected, it is reasonable to withhold antibiotic therapy especially in patients who are clinically stable and present with clinical evidence suggesting a viral infection. Optimal total duration of antibiotic therapy should not be less than 10–14 days, unless azithromycin is used (duration of 5 days total). Continuation of case: The child is admitted to the PICU and continues to have oxygen desaturations despite an increase to 70% oxygen using HFNC at 12 L/min. She becomes lethargic with increased work of breathing. The patient is intubated and a chest tube is placed in the left pleural space. About 400 mL of frank pus is drained from the chest tube. 4 5 6

What are the most common causes of pleural effusion? What are the characteristics of an exudative effusion? What is the management of pleural empyema?

Figure 1.1 Chest X-ray.

Rationale and Evidence-based Practice Explanation

What are the most common causes of pleural effusion? See Table 1.4.

What are the pathologic findings on the X-ray? There is a large left pleural effusion with atelectasis of the left lung. Atelectasis is suspected because of shifting of the mediastinum toward the left suggesting volume loss.

What are the characteristics of an exudative effusion (empyema)? See Table 1.5.

Chapter 1 Complication of Pneumonia

Table 1.3 Pathogens causing pneumonia in infants and children. Cause

Age and epidemiology

Common complications

Group B streptococci

Neonates

Shock, respiratory failure, apnea

Streptococcus pneumoniae

3 weeks to 4 years, asplenia, immunosuppressed

Consolidation, pneumatoceles, empyema, shock

Bacterial

Staphylococcus aureus

Infants

Pneumatoceles, empyema

Mycoplasma pneumoniae

>5 years; summer to fall

Atypical pneumonia

Group A streptococci

>5 years

Empyema, pneumatoceles

Chlamydophila pneumoniae

Adolescents

Atypical pneumonia

Chlamydia trachomatis

Neonates

Associated with conjunctivitis

Mixed anaerobes

Underlying pulmonary disease

Aspiration and necrotizing pneumonia, pneumatoceles

Gram-negative enterics (Pseudomonas)

Neonates

Hospital-acquired pneumonia, necrotizing pneumonia, shock

Viral: infants and children 200 mg/dL); (ii) venous pH 15 mmol/L), and BOHB (5 mL/kg per hour) of dilute urine (specific gravity 295 mosmol/kg). Diabetes insipidus is distinguishable with polyuria and polydipsia in uncontrolled diabetes mellitus or other forms of solute diuresis by the absence of glucosuria and a relatively normal rate of total urinary solute excretion.

Head CT.

Table 89.1 Basic metabolic profile. Sodium

158 mEq/L

Potassium

2.9 mEq/L

Chloride

102 mEq/L

Carbon dioxide

22 meq/L

Blood urea nitrogen

28 mg/dL

Creatinine

0.8 mg/dL

Glucose

110 mg/dL

Calcium

8.2 mg/dL

Continuation of case: This 14-year-old is diagnosed with post-traumatic diabetes insipidus. His central venous pressure (CVP) decreases from 7 to 4 mmHg. In children with altered consciousness, hypotonic polyuria can rapidly lead to hypovolemia and hypernatremia. Rapid and accurate assessment of the patient’s volume status is a crucial component of clinical management. Hypovolemia is associated with adverse outcomes in the child with severe TBI, and therefore initial therapy includes rapid volume expansion with 20 mL/kg of 0.9% normal saline administered over 10 minutes. 3 4 5

What additional therapies would be recommended at this time? What determines if the therapy was effective? Should any other diagnostic studies be obtained?

Why are children with severe traumatic brain injury at risk for diabetes insipidus? Neuroendocrine dysfunction can be a consequence of TBI and is a result of both anterior and posterior pituitary insufficiency. TBI can directly and indirectly lead to damage of the ADH-producing neurons, their axons, or the posterior pituitary resulting in post-traumatic diabetes insipidus. The pituitary gland and stalk are at particular risk of direct injury in high-speed acceleration–deceleration shear-type injuries, because the stalk is surrounded anatomically by the rigid diaphragma sellae and the gland is encased within the rigid bony sella. The rotational velocity of the head may result in stretching or tearing of small vessels or neuronal structures in the hypothalamic–pituitary unit. Indirect injury to the hypothalamic–pituitary unit can result from small vessel damage, inflammatory edema, and hypoxia. The incidence of acute post-traumatic hypopituitarism of any anterior pituitary hormonal axis is 50–76%. The incidence of posterior pituitary dysfunction (diabetes insipidus) in the acute state following moderate or severe TBI is approximately 20% and permanent diabetes insipidus develops in approximately 7% of patients. It is often difficult to remember differences between SIADH, CSW and diabetes insipidus (see Table 89.2). SIADH occurs for a variety of reasons, including TBI,

Chapter 89 Complication of Traumatic Brain Injury

Table 89.2

Characteristics of diabetes insipidus, SIADH and CSW. Diabetes insipidus

SIADH

CSW

Serum sodium

High

Low

Low

Serum osmolarity (mosmol/kg)

>295