What is the most appropriate additional laboratory test to establish the diagnosis? Parents bring their 3-day-old to the emergency department with the chief complaint of “lethargy and poor feeding.” He was born at term and after a short stay in the nursery, had been sent home on his second day after birth. He seemed to be breastfeeding well in the nursery, but today he was very sleepy, difficult to arouse, and had several nonbilious, nonbloody emesis. Family history includes a sibling who died in the first 2 weeks after birth for unknown reasons. On physical examination, his temperature is 37.2°C, heart rate is 168 beats/min, respiratory rate is 64 breaths/min, blood pressure is 66/30 mm Hg, and oxygen saturation is 98% on room air. He is listless and difficult to arouse. He withdraws and grimaces with painful stimuli. Lungs are clear to auscultation and heart sounds are normal. No hepatomegaly is present. There is mild facial jaundice and capillary refill time is 2 to 3 seconds. Point-of-care testing reveals a glucose level of 72 mg/dL (4 mmol/L). You obtain intravenous access and start a full sepsis workup. Subscribers: To see the preferred answer to January Question #2, go to PediaLink.org/, log in, and launch 2014 PREP E-Med under the CME tab. Not a subscriber? Order PREP E-Med today at prepemed.aap.org/index.cfm/Subscribe
Posted on: Thu, 30 Jan 2014 15:08:10 +0000
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