A study on the 'appropriateness' of 267 consecutive emergency admissions to a district paediatric department showed that admission was at a peak in the evening and night time. Breathing difficulty, head injury, and fever were the commonest presenting problems. Sixty three per cent of admissions occurred between 6 pm and 8 am and these were more likely to be after self referral to the accident and emergency department and were evenly distributed through the social classes. Overall 80/5% of admissions were considered to be necessary on medical grounds by the. consultants at the time of discharge. Parental assessment of severity of illness and need for admission correlated well with that of the doctors. Fifty two per cent of all admissions took place though the accident and emergency department, and although a higher number of these were from disadvantaged families these were equally appropriate on medical grounds to those sent for admission by the general practitioner. Altogether 26.5% of admissions were for less than 24 hours and half of these were judged to be unnecessary.
Congenital adrenal hyperplasia (CAH) due to 21-hydroxylase de ciency is a possible cause of hyponatraemia in the neonate. Elevated 17-hydroxyprogesterone (17-OHP) is considered diagnostic of the condition, although there have been reports of anomalous high concentrations, up to 110 nmol/L, in premature, sick infants subsequently shown to have normal adrenocortical function.We describe a case of a 6-week-old girl with a chest infection and hyponatraemia whose plasma 17-OHP concentration was 300 nmol/L, well within the range associated with 21-hydroxylase de ciency. However, there was no genital ambiguity and plasma cortisol was also signi cantly elevated, raising the possibility of generalized adrenal hyperstimulation rather than CAH. The patient was treated with antibiotic and saline infusions but no steroids. CAH was subsequently excluded by normal 17-OHP and cortisol responses to Synacthen stimulation.In sickness, an increased plasma 17-OHP concentration may not be synonymous with 21-hydroxylase de ciency, even when grossly raised. Simultaneous measurement of plasma cortisol could aid interpretation and avoid potential misdiagnosis, especially in male infants.
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