By Tim Barrett, A Lander, V Diwakar

A whole revision of this winning pocketbook, the fourteenth variation of A Paediatric Vade-Mecum offers the junior physician and trainee grade paediatrician with beneficial details at the prognosis and administration of affliction in young children, and with functional evidence-based recommendation for the secure and potent administration of the ill child.

Retaining the easy-to-digest type that has made past versions so well known, the content material has been restructed into 5 significant sections: acute paediatric difficulties, outpatient paediatrics, formulary, common values and thesaurus of phrases, with entries in sections 1 and a couple of organised alphabetically for ease of reference. Pre-registration residence officials, SHOs and SpRs in Paediatrics, and GPs in education shouldn't be and not using a own replica.

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Metabolic investigations to exclude glutaric aciduria. Consider if no other evidence of trauma: • urine organic acids (GLC), in particular 3-hydroxyglutarate and glutarate; • blood for carnitine and acyl carnitine analysis (in particular glutaryl carnitine); • skin biopsy for enzyme analysis (to detect non excretors) should only be considered if there are accompanying findings such as positive family history, indicative MRI changes (frontotemporal atrophy and widening of the Sylvian fissure), prior macrocephaly and additional neurology (dystonia, jitteriness).

CYANOTIC CONGENITAL HEART CONDITIONS The common causes are transposition of the great arteries, Fallot’s tetralogy, pulmonary atresia and tricuspid atresia. qxd 9/6/02 5:36 PM Page 28 Acute paediatrics 28 • CARDIOLOGY anomalous pulmonary venous drainage should always be suspected in the blue baby with respiratory distress. DIAGNOSIS Cyanosis is readily confirmed by pulse oximetry. Most cases are not breathless. The main differential diagnoses are respiratory illness or persistent fetal circulation in which there is usually dyspnoea.

1. g. salicylates). 2. First-line investigations: • FBC, peripheral film and platelet morphology; • PT and APTT; • TT; • fibrinogen. 3. Second-line investigations should be done in consultation with a haematologist, especially when there is a positive family history or any abnormality detected in first-line investigations: • platelet aggregation studies; • factor assays; • von Willebrand screen; • anti-plasmins. Radiology 1. A skeletal survey is not always necessary but should be considered in the following situations: • presentation with a fracture which suggests abuse; • physically abused child under 2 years; • older child with severe soft tissue injury; • infant dying suddenly and unexpectedly.

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