Chapter 33: Pediatric Metabolic and Endocrine Problems

0 degrees Celsius or higher require immediate assessment and intervention, with particular caution in neonates under one month old who necessitate emergency evaluation. Dehydration represents a significant risk in the pediatric population due to immature kidney function and proportionally higher extracellular fluid volumes, necessitating careful assessment of clinical indicators such as fontanel depression, skin turgor changes, and urine concentration, with treatment ranging from oral rehydration solutions for mild cases to intravenous fluid administration for severe depletion. The chapter addresses phenylketonuria, an autosomal recessive disorder causing dangerous accumulation of the amino acid phenylalanine that results in neurological damage if untreated, mandating universal newborn screening and lifelong dietary phenylalanine restriction to prevent intellectual disability and behavioral complications. Childhood obesity emerges as a significant health concern affecting physical and psychological development, classified by BMI percentiles and associated with metabolic complications including type 2 diabetes, cardiovascular disease, and sleep-related disorders. The chapter provides comprehensive coverage of diabetes mellitus in children, contrasting the absolute insulin deficiency of type 1 diabetes with the insulin resistance characteristic of type 2 disease, and detailing management strategies including balanced nutrition, appropriate exercise adjustments, and sick day protocols that maintain insulin administration during illness to prevent ketoacidosis. Critical acute complications receive substantial attention, particularly hypoglycemic episodes requiring immediate carbohydrate administration and diabetic ketoacidosis, a life-threatening metabolic emergency characterized by severe hyperglycemia, ketosis, and metabolic acidosis that demands rapid fluid resuscitation and electrolyte monitoring to restore physiological stability and prevent mortality.