Download Table 5. Normal Glomerular Filtration Rate (GFR)

PHYSiOLOGY
and Electrolytes
Fluids
SUGGESTED
READING
Anderson S. Garcia DL, Brenner BM. Renal
and systemic manifestations
of glomerular
disease. In: Brenner BM, Rector FC Jr, eds.
The Kidney, 4th ed, Vol II. Philadelphia,
PA: WB Saunders Co; 1991;1831-1870
Briggs JP, Sawaya BE, Schnermann
J.
Disorders
of salt balance. In: Kokko JP,
Tannen RL, eds. Fluidc and Electro’ytes,
2nd ed. Philadelphia,
PA: WB Saunders Co;
1990:70-138
Darrow DC. A Guide to Leanzing
Fluid
Therapy.
Springfield,
IL: Charles C Thomas
Publishers;
1964
Finberg L, Kravath RE, Fleischman
AR.
Water and ElectroIytes
in Pediatrics.
Philadelphia,
PA: WB Saunders Co; 1982
Fanestil DD. Compartmentation
of body water.
In: Maxwell MH, Kleeman CR, Narins RG,
eds. Clinical Disorders
ofFluid
and
Electrolyte
Metabolism,
4th ed. New York,
NY: McGraw-Hill
Book Co; 1987:1-13
Guyton AC. The lymphatic system, interstitial
fluid dynamics,
edema, and pulmonary
fluid
and partition of the body fluids: Osmotic
equilibria
between extracellular
and
intracellular
fluids. In: Guyton AC.
Textbook ofMedical
Physiology,
7th ed.
Philadelphia,
PA: WB Saunders;
1986:361371; 382-392
Holliday MA. Body composition,
metabolism,
and growth. In: Holliday MA, Barratt TM,
Vernier RL, eds. Pediatric Nephrology,
2nd
ed. Baltimore,
MD: Williams & Wilkins;
1987:3-13
Reineck Hi, Stein JH. Sodium metabolism.
In:
Maxwell MH, Kleeman CR, Narins RG,
eds. Clinical Disorders
of Fluid and
Electrolyte
Metabolism,
4th ed. New York,
NY: McGraw-Hill
Book Co; 1987:33-59
Schwartz
GJ, Haycock GB, Edelmann CM Jr,
Spitzer A. Late metabolic
acidosis: A
reassessment
of the definition.
J Pediatr.
1979;95:102-107
Table 5. Normal
Infancy
Glomerular
AVERAGE
GFR
ML/MINII.73
M
AGE
2-8 days
days
37-95 days
1-6 months
6-12 months
12-19 months
2-12 years
with permLssion
Heilbron
glomerularfihtration
rate
DC, Holliday
Pedlati
in children,
are correct
statements
regarding normal and
abnormal
body compositions
except:
A. Diarrhea represents
an exampie of excessive
losses of
D.
14.
True statements
tive osmolality
solute.
regarding
effec-
for thirst
are set at
glucose.
C. A normal serum osmolality
of about 280 mOsm/kg
is
maintained
by control of
water balance.
D. Most infants by I month of
age can vaiy urinary concentrations
of solute from 50 to
of age.
fluid corn-
partment
approximates
40%
in both the infant and the
adult.
1000 mOsm/L.
correct
statement
garding basal metabolic
(BMR) is:
E. The serum proteins account
for the normal difference between
serum
and intracellular
re-
rate
A.
The higher BMR of infants
results from the greater contribution of “central
organs”
to body weight.
B. The impact of fever on BMR
necessitates
a 10% decrease
of estimated fluid for insensible loss for each degree cen-
tigrade above normal.
C. The basal energy expenditure
of the liver
is the single
est factor in determining
13.
hypercholestemle-
be accurately
estimated
from
measured
serum concentrations of sodium,
urea-N,
and
weight attains 20% by 3
D.
84.
different levels of plasma osmolality.
B. Total serum osmolality can
A person’s
extracellular
water contribution
to total
The most
Familial
sponsible
fluid compartment
is determined by the quantity of sodium present because
sodium
ions contribute effective cx-
years
MA, al-Dahwi
A, Kogan
NephroL
1991; 5:5-11.
of body fluids
and their controls include all of
the foilowing except:
A. The osmoreceptors regulating
release of ADH and those re-
nemia-hypovolemia-
E. The intracellular
M
E. Diabetes mellitus.
edema sequence.
C. The size of the extracellular
12.
RANGE
ML/MIN/1.73
mia.
transcellular
fluid.
B. Current studies support the
concept
of the hypoalbumi-
tracellular
DurIng
17-60
26-68
30-86
39-114
49-157
62-191
89-165
PIR QUIZ
11. All of the following
D.
Rate (GFR)
39
47
58
77
103
127
127
4-28
Reproduced
Expressing
Filtration
BMR of infants.
In the adult, muscle mass
counts for approximately
50% of the BMR.
largthe
ac-
Factitious
hyponatremia
may occur in each of the following
except:
A. Hypothyroidism.
B. Hyperglycemia.
osmolality.
15.
Of the following,
the most correct statement regarding Hf-ion
balance is:
A. In the growing
daily endogenous
load approximates
rnEq/day.
child, the
H-ion
8 to 10
B. The synthesis of “new”
HCO3normally matches
that consumed in buffeting
endogeneous
H-ion load.
C. Greater renal resorption of
D.
HCO3results in higher
serum HCO3levels in
infants versus adults.
A vegetarian
diet adds to the
daily H-ion
load requiring
elimination
to maintain
homeostasis.
C. Addison disease.
Pediatrics
in Review
VoL 14
No. 2
February
1993
79
‘\
American
Academy
of Ped iat r ics
Continuing
Programs
Annual
Education
Meetings
Washington,
DC
October 30-November
Spring
Chicago,
3, 1993
20-24,
Denver,
1993
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Education
1994
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April 23-27,
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Medical
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Pediatrics
1993
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March 5-7, 1993
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Traverse City, Michigan
September
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Stateof-the-Art
Pediatrics
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May 14-16, 1993
.
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October 22-26,
Sessions
Illinois
March
d
State-of-the-Art
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Atlantic City, New Jersey
September
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.
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May 28-30, 1993
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San Francisco,
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October 8-10, 1993
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Washington,
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June 18-20, 1993
To those enrolled in PREP (Pediatrics
Review and Education
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‘#4/
Board of Pediatrics#{174}
rog ram fo r Renewal
of Certification
in Pediatrics
Guides
for Record
Review
Chronic
Abdominal
Pain
Supplement
to Pediatrics
in Review
The
Chapel
American
Board
of Pediatrics
111 Silver Cedar
Court
Hill, North
Carolina
27514-1651
@1993 by the American
All Rights
Board
Reserved
of Pediatrics
This guide has been prepared
by the American
Board of Pediatrics
(AB?)
as an integral
part of the record
review
required
for renewal
of certification
in
general
comprehensive
pediatrics.
Its purpose
is to provide
the pediatrician
with criteria
for assessing
patient
records
dealing
with specific
problems.
Important
elements
to be included
in the record appear
in bold-face
type in the
margins;
other elements
to be considered
are printed
in italics.
Theguides
focus on the elements
of the history
and physical
examination
relevantto
specific
problems
and are not meant to discourage
a more thorough
history
and physical
examination
as appropriate
for the patient
and the
particular
circumstances.
The
guides
knowledge
these
tional
will
be updated
and their
should
be verified
is included
in each
about
guides
units
drugs
periodically.
availability,
in current
guide.
Because
drugs
and
sources.
of rapid
dosages
A table
changes
in
included
in
of interna-
The
guides
are planned,
written,
and reviewed
by an ABP committee
composed
primarily
of practicing
pediatricians.
Appropriate
subject
experts
are consulted
during
the preparation
of the guides.
.
Please
articulate
solely
Distribution
Pediatrics
note
that
standards
to address
of this guide
through
a license
these
guides
do not purport
of care
They are 4esigned
record
keepIng
Issues
is made
agreement
possible
by the American
with the American
Board
to.
Academy
of Pediatrics.
of
INTRODUCTION
Chronic
or recurrent
abdominal
pain is one of the most common
and
challenging
complaints
evaluated
by pediatricians.1
Depending
upon
the
frequency
and severity
of the complaint
and the child’s and family’s
response
to it, considerable
school can be missed,
and considerable
expense
entailed
as
a result
of medical
evaluation
and therapy.
The etiology
has frequently
been
divided
into organic,
functional,
and psychologic
causes,2
but these are not
mutually
exclusive
and all avenues
should
be explored
in the evaluation
of the
child with chronic
or recurrent
abdominal
pain. Functional
pain is considered
to be of probable
organic
origin
(eg, hypermotility
of the bowel)
even though
no organic
cause
can be identified;
this type of pain should
not be ascribed
to
psychologic
causes
if there is little or no evidence
for psychopathology.
This unit considers
children
from 3 years of age to puberty
whose
have been present
for at least three months
and have been characterized
persistence
or recurrence
over that time period.
PATIENT
pains
by
IDENTIFICATION
The age of the patient
or birth
date should
be recorded
because
the
common
causes
of abdominal
pain tend to differ with age; for example,
peptic
ulcer disease
and inflammatoryboweldisease
are more common
after lOyears
ofage. Raceshould
alsobe
noted, for sickleceildisease
isa causeofpaininblack
persons,
and lactose
intolerance
is a frequent
cause
of symptoms
in black,
Mediterranean,
Indian,
and Asiatic children
older than 4 years ofage.3 Gender
may be significant,
for urinary
tract infections
and pelvic
abnormalities
are
more common
in girls. An up-to-date
record
of all immunizations
should
be
a part of each child’s
medical
record.
Finally,
any drug allergies
should
be
recorded
prominently
on the chart
so that a drug
to which
the patient
is
sensitive
is not prescribed
inadvertently.
PATiENT
Birth
date
Race
Gender
Immunizations
Drug
allergies
HISTORY
A detailed
description
of the abdominal
pain is essential
to the interpretation of its likely cause.
The location
and any tendency
to radiate
should
be
noted,
as well as the character,
duration,
and severity
of the pain. Radiation
of
pain to the back occurs
in posterior
duodenal
ulcer and pancreatitis,
whereas
pain
from
gallbladder
disease
radiates
to an area between
the scapulae.
Epigastric
pain isassociated
withdistalesophagitis,
gastritis,orulcer,
and with
pancreatitis.
Leftupperquadrantpain
may representgastritis,gas
trapping,or
lesions
in the jejunum
or splenic
flexure
of the colon. Pain in the nght upper
quadrant
is likely due to hepatobiliary
disease,
perihepatic
inflammation,
or
duodenal
ulcer. Right lower quadrant
pain suggests
appendiceal,
ovarian,
or
inflammatory
bowel
disease.
Left lower quadrant
pain is usually
caused
by
colitis or constipation.
Periumbilical
pain is less specific
for an organic
abnormality
but it may represent
small bowel
disease.
I
Description
of pain,
including location,
5verftY,f1uency,
character
om ng
Description of stools
(eg constipation)
Weight
Loss
gastritis,
colomc
Fever
Family
history
of
,
sease
Family history
depression
Social
history
il
tory
Characteristics
of the pain and its duration
are important;
or ulcer pain is described
as burning
or gnawing,
and
pain as cramping.
The pain of esophagitis,
ulcer disease,
bowel
particularly
pain, which
of
present
tract
neal
esophagitis,
small bowel or
or inflamma-
disease
may awaken
the patient
from sleep; esophageal
pain is
prominent
upon awakening,
in contrast
to functional
abdominal
rarely disturbs
a child’s
sleep. Peptic
ulcer pain is most typically
an hour or two after
disease,
or inflammatory
pain is dull, aching,
and
meals. The pain of esophagitis,
gastritis,
biliary
bowel
disease
is aggravated
by eating.
Peritoworsened
by bumping
or jumping
motions.
(eg,
environmental
or
chronic stress)
The effect of time ofday, physicalactivity,
schoolattendance,
and the like
may provide
clues
to etiology.
If the child is receiving
any medication,
a
relationship
between
the drug and the pain should
be explored.
If the child has
had previous
studies
or treatment
for the complaint,
the results
should
be
recorded.
Finally,
the degree
of incapacity
(that is, the response
of the child to
the pain) should
be noted;
pain that interferes
with school
attendance,
play
activities,
or sleep is of concern.4
The history
should
also include
the presence
of any weight
loss or recent
failure
to gain weight,
which
would
favor
an organic
cause.
The child’s
appetite
and diet should
be evaluated,
particularly
any unusual
intake,
such
aslarge
amounts
offoods
ormedicines
containingsorbitol,6excessive
amounts
of fruit juice, or frequent
ingestion
of chocolate
or popcorn.
The history
of
vomiting
and whether
vomitus
was bile stained
or bloody
should
be noted
in
the chart.
The presence
of low-grade
or recurrent
fever may be a clue to
inflammatory
bowel
disease
or infection.
Urinary
tract disease
is a common
cause of abdominal
pain, and its presence
may be indicated
by the complaints
of dysuria,
frequency,
flank or suprapubic
pain, and hematuria.
The character
ofstoolsshouldbeascertainedbecausethepresenceofblood
ormucussuggests
colitis,
whereas
fatty and foul-smelling
stools indicate
the possibility
of malabsorption.
Constipation
may be one of the most common
causes
of persistent
abdominal
pain,
so the frequency
and hardness
of the stools
should
be
determined.’
Distention
and flatus
are clues to disorders
such as lactose
intolerance8
or giardiasis.
The review
evidence
of other
chest discomfort,
withoutobjective
if there is evidence
of systems
should
be complete,
but should
particularly
seek
potentially
functional
complaints,
such as headache,
vague
anorexia
without
weight
loss, or joint and extremity
pain
manifestions.9”#{176}Thepreviousmedicalhistory
maybe
helpful
of milk intolerance,
gastroesophageal
reflux, or encopresis.
Children
with functional
recurrent
abdominal
pain usually
are
strung”
and excitable,
and may be apprehensive,
timid,
or perfectionistic.
pattern
ofover-reaction
to minor illnessor
injury maybeuseful
as evidence
the parent(s)
may be overly
anxious.
“high
A
that
The familyhistory
should focusongastrointestinaldisease,
such as peptic
ulcer,
spastic
colon,
and lactose
intolerance.
Because migraine
and seizure
disordersare
causesofabdominal
pain, though
uncommon,
a family history
of
these complaints
may be helpful.4
A strong
relationship
between
maternal
depression
and recurrent
abdominal
pain in her child has been reported,
so
evidence
of psychiatric
illness in the family
may be important.11”2
The social
environment
history
may shed
and on thecontribution
light on the degree
of stress
in the child’s
ofchronic
stress to the patient’s
complaints.
2
PHYSICAL
EXAMINATION
Abdominal
pain can be a manifestation
of disease
in many
other organ
systems,
so a thorough,
complete
physical
examination
should
be done.
The
height
and weight
should
be recorded,
because
an impairment
in growth
can
be an important
clue to the presence
of an organic
cause
of the pain. The
temperature
may be useful
for reasons
noted
above.
Given
the possible
presence
of a urinary
tract abnormality,
the blood
pressure
should
also be
recorded.
The resuitsofa
detailed
abdominalexamination
should
be available,
including
the presence
of masses
or enlarged
organs,
any tenderness
or
distention,
and the description
of the peristaltic
sounds.
A rectal examination
may be useful
to search
for fecal or other masses,
to ascertain
the character
of
the feces, and to provide
a specimen
for examination
for occult blood.
LABORATORY
AND
RADIOLOGIC
Height/length
Weight
pressure
Blood
Abdomen
examination
Rectal
STUDIES
Because
most chronic
and recurrent
abdominal
pain has no identifiable
organic
origin,
no laboratory
or radiologic
study
is absolutely
indicated
in
every patient.”4
Rather,
studies
should
be selected
on the basis of the results
of a detailed
history
and physical
examination,
and the most likely cause for
the complaints.
However,
it is commonly
desirable
to perform
a noninvasive
and inexpensive
series of screening
examinations,
negative
results
of which
will reassure
both the physician
and parents
that organic
disease
is less likely
to be present.
For example,
a complete
blood count may provide
evidence
of
anemia,
lead poisoning,
parasitic
disease
or allergy
(eosinophilia),
and other
causes
of recurrent
pain. An erythrocyte
sedimentation
rate may be helpful
in
considering
a disorder
such as inflammatory
bowel
disease.
Several
stool
examinations
for occultblood
canbe helpful
in identifying
sources
of bleeding,
such as peptic
ulcer or a Meckel
diverticulum.
A complete
urinalysis
and, in
girls, a urine culture
will be helpful
in the elimination
of urinary
tract disease
as the cause of abdominal
pain.
Depending
upon the history,
physical
examination,
and screening
laboratory
findings,
further
studies
are sometimes
indicated,
but should
not be
done indiscriminately
in the absence
of adequate
indication.
These
include
stool pH and examination
for reducing
substances
which may identify
carbohydrate
intolerance,
and stool examinations
for ova and parasites
or bacterial
pathogens.
Stool studies
for fat may be helpful
in documenting
suspected
steatorrhea,
and an excessive
number
of leukocytes
in stool may be found
in
patients
with
various
forms
of colitis.
Where
available,
breath
hydrogen
studiescan
be usefulinconfirming
the presence
ofcarbohydrate
intolerance.3”3
Ultrasonography
is the least invasive
method
for evaluating
renal or
pelvic abnormalities
and diseases
of the gallbladder
or biliary
tract, providing
that the radiologist
is experienced
with such examinations
in children.
X-ray
studies
of the abdomen
may identify
evidence
of unsuspected
constipation,
abnormal
gas patterns,
calcifications,
and some masses.
Contrast
studies
such
as upper
gastrointestinal
series
and barium
enema
examination
should
be
reserved
for those situations
in which there seems a reasonable
likelihood
that
an identifiable
disease
will be found,
rather
than as screening
procedures.
Radioisotopic
scans
have been used in the identification
of a Meckel
diverticulum, although
both false-positive
and false-negative
results have been reported.
3
Temperature
Complete
blood
Erythrocyte
sedimentation
, ,
.
‘ll
count
rate
I
YSiS
Urine culture
Stool for occult blood
TREATMENT
Dietary
counseling
Drug therapy
Treatment
will be dependent
upon
the findings
and the
Specific
treatment
for specific
abnormalities
such as peptic
ulcer
inflammatory
bowel disease
is beyond
the scope of this discussion,
diagnosis.
disease
or
which
will
focuson
thechild
with “functionalabdominalpain”
for which noorganic
origin
is apparent
or suspected.
Both parents
and the patient
will need a careful
interpretation
of these findings,
and a clear explanation
of why no further
studies
are needed
if that judgment
has been made. Considerable
reassurance
may be required
(see Patient
Education).
Many
treatments
have
been
used
in the management
of functional
abdominal
pain, with varying
levels of success.
The treatment
of constipation,
when present,
may be helpful
in reducing
abdominal
pain.1’
Dietary
counseling,emphasizinga
nutritiousdietwith
adequatefiberand
bulk,’6and
the use
of stool softeners
may be helpful in children
whose
bowel patterns
or physical
findings
indicate
significant
constipation.
The cessation
of sorbitol
ingestion
hasbeenassociated
with reliefin
a few patients,’and
a trial ofa lactose-free
diet
may be worthwhile
in patients
thought
to have lactose
intolerance.8
Sources
of anxiety
and stress should
be identified
and an effort made to
reduce
pressure
for performance
in school,
to reduce
unnecessary
stress, and
to reduce
intrafamilial
tensions.1#{176} Relaxation
techniques
may be helpful
in
children
old enough
to cooperate,
as for other types of chronic
pain.’5
For the
child who is missing
considerable
school
and has no evidence
of significant
organic
disease,
regular
attendance
is mandatory.
The prescription
of
antispasmodic
drugs,
antacids,
or other medications
is discouraged
because
they are seldom
effective
and tend to reinforce
the idea that there is something
wrong
with the child, even though
no disease
has been identified.
FOLLOWUP
Regular followup
visits
EVALUATION
Children
with recurrent
abdominal
pain should
beevaluated
regularly
in
follow-up,
with particular
attention
to growth
and to any change
in symptoms
or findings
on physical
examination
that may warrant
further
investigation.
Continued
support
and reassurance
must be given if there continues
to be no
evidence
of organic
disease,
and previous
instructions
may need
periodic
reinforcement.1’
Continued
efforts
should
be made
to resolve
family
and
school
issues
which
may be contributing
to environmental
stress.
Each visit
should
be documented
in the patient’s
record.
The longer
a child is observed
and hasnoevidenceoforganic
disease,
thelesslikely
itis thata hidden
problem
is being
missed.
When
organic
disease
is suspected,
consultation
with
a
pediatric
gastroenterologistmaybe
indicated
before an extensiveevaluation
is
initiated
for suspected
organic
disease
to direct the evaluation
along appropriate
lines (eg, upper
or lower
endoscopy
to rule out esophagitis,
gastritis,
peptic
ulcer, colitis,
or other lesions).’”8
4
PATIENT
EDUCATiON
Education
of the child and family is one of the most important
aspects
of
management
of this troublesome
problem.
Both need to be assured
that the
pain isreal, and thatthe
child isnot malingering.
The pediatrician
should
avoid
stating
that “nothing
is wrong”
or implying
this by saying,
“I cannot
find
anything
wrong.”
A physiologic
explanation,
including
the possibilities
that
gastrointestinal
motility
is disturbed,’9
that intraluminal
tension
is increased,
and that these may be particular
responses
to environmental
stress (as occurs
inadults)isoften
helpful.”2’4’
Techniquesmay
beused
toreduceany
secondary
gain by the child, such as insistence
on regular
school
attendance,
continued
responsibility
for choresaround
the home, and thelike.
Considerable
counseling may be needed
to discourage
parents
from seeking
multiple
medical
and
surgical
opinions
for further
diagnostic
evaluations
and treatment.
If parental
illness
such as depression
is thought
tobe contributing
to the problem,
parents
may be advised
to seek help for themselves.”
The recurrent
nature
of the
problem,
and the importance
of periodic
re-evaluation,
should
be stressed.
The management
of persistent
or recurrent
abdominal
pain in childhood
can be time-consuming
and frustrating
for pediatricians,
but with a comprehensive
approach
to the possibility
of functional,
psychologic,
or organic
diagnoses;
careful
evaluation;
and comprehensive
counseling,
considerable
relief can be provided
to the patient
and his or her family.
The pediatrician
should
keep in mind that no matter what the etiology
of thecomplaint,
thechild
does hurt.
5
Counseling
cause
about
of pain
REFERENCES
I
.
Coleman
WL, Levine MD: Recurrentabdominalpain:
and the aches of the cost. Pediatr Rev 8:143,
2.
Olson
A: Recurrent
management.
Pediatr
3.
Wald A, Chandra
abdominal
pain
4.
Levine MD, Rappaport
thelonelinessofthelong-distance
1984
5.
Barbero
6.
Hyams
JS: Chronic
Pediatr
100:772,
7.
abdominal
Ann 16:834,
R, Fisher
of childhood.
pain:
1987
approach
LA: Recurrentabdominalpain
physician.
PediatrClin
inchildhood.
abdominal
pain
and
in recurrent
in schoolchildren:
North Am 31 :969,
PediatrRev4:29,
1982
caused
by sorbitol
malabsorption.
to clinical
47:666,
findings
1972
in children
I
1982
SB: Transit
abdominal
time
pain.
8.
Liebman
WM: Recurrent
intolerance,
a prospective
9.
OsterJ:
Recurrent
and adolescents.
related
Pediatrics
abdominal
Pediatrics
pain,
50:429,
headache,
1972
and
Robinson
DP, Greene
JW, Walker
LS: Functional
adolescents:
relationship
to negative
life events,
characteristics.
J Pediatr 1 13:588, 1988
Ii.
Hodges
K, Kline JJ, Barbero
with recurrentabdominalpain
12.
Zuckerman
community
13.
Barr RG, WatkinsJB,
excretion:
comparative
nonspecific
abdominal
14.
Feldman
W, McGrath
P, Hodgson
management
of simple,
childhood,
Am J Dis Child 139:1216,
1985
15.
Olness
ment.
limb
Czinn
SJ, Speck
114:670,
1989
17.
Caulfield
endoscopy
North
WT:
sucrose
in children
complaints
in
and family
G, et al: Depressive
symptoms
and in their families.JPediatr
in children
107:622,1987
and headaches
79:677,
1982
in a
PermanjA:
Mucosal
function
and breath
hydrogen
studies
in the clinical
evaluation
of children
with
complaints.
Pediatrics
6&526, 1981
K: Hypnotherapy:
16.
pains
somatic
self-concept,
B, Stevenson
J, Bailey V: Stomachaches
sample
of preschool
children.
Pediatrics
Clin
with
abdominal
pain in children:
lactoseand
study.
Pediatrics
64:43, 1979
10.
Pediatr
the aches
to diagnosis
SE, et al: Lactose
malabsorption
I Pediatr 100:65, 1982
GJ: Recurrentabdominalpain
Dimson
recurrent
an
the costof
1986
Am
C, et al: The use of dietary
fiber
idiopathic
recurrent
abdominal
a cyberphysiologic
36:873, 1989
Campylobacter
pylon:
strategy
a new
in pain
pathogen.
M, Wyllie
R, Sivak MV Jr. et al: Upper
gastrointestinal
in the pediatric
patient.
J Pediatr 115:507, 1989
6
in the
pain.
manage-
J
Pediatr
tract
18.
Steffen
patient.
RM, Wyllie
R, Sivak MV Jr, et al: Colonoscopy
J Pediatr 115:507, 1989
19.
Pi#{241}eiro-Carrero
VM, Andres
JM, Davis RH, et al: Abnormal
denal
motility
in children
and adolescents
with recurrent
abdominal
pain. J Pediatr 113:820,
1988
7
in the
pediatric
gastroduofunctional
CONVERSION
TABLE
INTERNATIONAL
I.
II.
III.
IV.
TO STANDARD
(SI) UNITS
Hematology
Hemoglobin
g/dL x 0.155
Platelets/mm3
Leukocytes/mm3
Erythrocytes/mm3
Hematocrit
% x 0.01
Reticulocytes
% x 0.01
Blood
Pressure
mm Hg (tori)
=
mmol/L
count/p.L
= 10’ cells/L
count/jLL = 10’ cells/L
count/j.LL = 10’ cells/L
vol RBC/vol
whole blood
(1)
=
mbar
=
=
=
=
=
x 1.333
Blood Gases 1 mm Hg = 133.322
Base excess mEq/L = mmoVL
pH value = same
Pa
PCO2 mm Hg x 0.1333
P02 mm Hg x 0.1333
Blood Chemistries
Acetone
mg/dL x 0.1722
Acetaminophen
ig/mL
x 6.62
Albumin
g/dL x 144.9 or gIL x 14.49
Aldosterone
ng/dL x 0.0277
Ammonia
mgN/dL
x 0.714
Bicarbonate
mEjL
Bilirubin
mg/dL x 17.10
Blood urea nitrogen
mg/dL x 0.357
Calcium
mg/dL x 0.25
Carotene
IU x 0.6
or jig/dL x 0.01863
Ceruloplasmin
mg/dL x 0.0662
Chloride
mEq/L
Cholesterol
mg/dL x 0.0259
Complement
component
(C3) mg/dL x 0.01
Copper j.Lg/dL x 0.157
Cortisol
j.tg/dL x 27.59
Creatine
mg/dL x 76.26
Creatinine
mg/dL x 88.40
Digoxin
ng/mL x 1.28
Enzymes
Alanine aminotransferase
(ALT, SGPT) U/L
Aldolase
Sibley-Lehninger
units/mL
Amylase
Somogyi
units/dL
Aspartate
aminotransferase
(AST, SOOT) U/L
Creatine
kinase (CK) U/L
Phosphatase
Bodansky
units/dL
King-Armstrong
units/dL
8
=
mmolIL
j.tmol/L
j.tmol/L
nmol/L
mmol/L
mmol/L
p.mol/L
mmol urea/L
mmol/L
jig
jimol/L
=
j.unol/L
=
=
=
=
=
=
=
=
=
=
=
mmolfL
mmol/L
g/L
j.unol/L
nmol/L
p.mol/L
jimol/L
nmol/L
=
U/L
=
U/L
=
U/L
=
U/L
U/L
=
=
=
=
=
=
=
=
=
=
U/L
U/L
=
=
kPa
kPa
Fatty
mg/dL x 0.0354
ng/mL x 1
a,-Fetoprotein
ng/mL x 1
Fibrinogen
mg/dL x 0.01
Folic acid jig/dL x 22.65
Glucose
mg/dL x 0.0555
Glycerol
mg/dL x 0.1086
Haptoglobin
mg/dL x 0.01 176
17-Hydroxyconicosteroids
mg/d x 2.759
Insulin IU x 0.04167
or jiU/mL
x 1.0
Iodine jig/dL x 78.8
Iron p.g/dL x 0.1791
Iron binding capacity
j.tg/dL x 0.1791
17-Ketosteroids
mg/d x 3.467
Lead j.tg/dL x 0.0483
Lipoprotein
mg/dL x 0.01
Magnesium
mg/dL x 0.4114
or mEq/L x 0.5
Phosphorus
mg/dL x 0.3229
Potassium
mEqjL
Prednisone
mg x 2.79
Protein g/dL x 10
Salicylate
mg/dL x 0.0724
Sodium
mEq/L
Theophylline
jig/mL x 5.55
Thyroid-stimulating
hormone
p.U/mL x 1
Thyroxine
jig/dL
x 12.87
Transferrin
mg/dL x 0.01
Triglycerides
mg/dL x 0.01
Triiodothyronine
ng/dL x 0.0154
Urea nitrogen
mg/dL x 0.357
Uric acid mg/dL x 59.48
Vitamin
A j.tg/dL x 0.0349
Vitamin
B12 pg/dL x 0.738
Vitamin
C mg/dL x 56.78
Vitamin
E jig/dL x 2.322
Xylose mg/dL x 0.0667
Zinc j.tg/dL x 0.153
acids
Ferritin
V.
VI.
VII.
Urine or Stool
Coproporphyrin
jig x 1.53
Epinephrine
jig/d x 5.458
Vanilmandelic
acid mg/d x 5.046
Homovanillic
acid mg/d x 5.489
Energy
Kcal x 4.1868
Rad x 0.01
Radionuclide
Curie (Ci)
mmol/L
p.gL
=
=
=
g/L
nmol/L
= mmol/L
= mmol/L
= jimol/L
= jimoVd
= mg
= mU/L
= nmol/L
= j.tmol/L
= jmiol/L
= .unol/d
= jimol,t
= g/L
= mmol/L
mmol/L
= mmol/L
= mmol/L
= j.tmol
= giL
= mmol/L
= mmol/L
= jimol/’L
= mU/L
= nmol/L
= g/L
= gIL
= nmol/L
= mmol
urea/L
= p.mol/L
= jimol/L
= pmol/L
= p.mol/L
= j.unol/L
= mmolfL
= jimol/L
=
=
=
=
=
=
=
KJ (Kilojoule)
Gy (Gray)
(joule/kg)
=
GGq
=
Activity
x 37
9
nmol
nmol/d
jimol/d
jimol/d
(Gigabecquerel)