STUDY TIPS FROM THE REVIEW COURSE

To pee or not to pee: Pro pointers for pediatric pee problems

January 6, 2018

 

 

Jodi is a 2 year old girl with fever who presents to your rural emergency department. Jodi's mother reports that she has been recently fatigued and complaining of non-specific abdominal pain. 

 

SNAP SAMP:

 

  1. List TWO risk factors that increase UTI in children. 

  2. What are THREE common organisms in UTI?

  3. Name TWO potential complications of UTI.

  4. How do you obtain a urine sample from this 2 year old girl? 

  5. What are THREE steps in your management of this child?

 

Answers:

 

1) 

  • Posterior urethral valves

  • Vesicoureteral reflux

  • Recent instrumentation

  • Constipation

 

2) KEEPS mnemonic:

  • K - Klebsiella

  • E - Enterococcus

  • E - E. Coli (80%) 

  • P - Proteus

  • S - Staph (15%)

 

3) 

  • Pylenonephritis

  • Acute renal failure

  • Sepsis

  • Abscess

 

4) Discussion with parents about bag sample vs. clean catch catheterization. Catheterization is the preferred method as it can reliably diagnose a UTI. However, it may cause discomfort to the patient and parents. A bag sample may be attempted but it is only helpful if the bag sample is negative. A positive sample may reflect contaminate and a new sample should be obtained by catheterization. 

 

Consider getting a midstream urine by Bladder Stimulation Technique - a novel approach at obtaining a non-invasive urine sample: 

http://www.adhb.govt.nz/newborn/Guidelines/Infection/UrineCollectByBladderStimulation.htm

 

5) 

  • Antibiotics - 7-10 day course in children, choices include:

    • Trimethroprim-sulfamethoxazole

    • Nitrofurantoin

    • Cephalexin

    • Amoxicillin

  • Tylenol or Advil for antipyretic and analgesia

  • Renal bladder ultrasound 

    • In children, this is done for all UTI less than 2 years old

    • Additionally, this should be done for 1st UTI in boys, or recurrent UTI in girls, or children with poor growth

       

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