pediatrics
Hypertensive Emergencies in Children
Diagnosis
Blood pressure (BP) measurement Testing for target organ involvement Elevated BP should be measured Diagnosis . In a hypertensive emergency, BP measurements are usually taken with an oscillometric device, which facilitates the frequent (as often as every 2 to 3 minutes) measurements required. However, the initial measurement should be confirmed by auscultation. Identification of conditions that would impact treatment is an immediate concern, especially an intracranial mass, uncorrected coarctation of the aorta, eclampsia, severe pain, sympathetic overactivity, or renal failure. In addition to history and physical examination findings, target organ involvement should be evaluated using tests that can be done quickly: ECG and chest x-ray to evaluate for heart failure and ventricular hypertrophy—if possible, an echocardiogram, which is much more accurate Urinalysis to screen for renal parenchymal disease Serum electrolytes, bloodureanitrogen (BUN), and creatinine to screen for kidney dysfunction (elevated creatinine) and adrenal abnormalities (low potassium) Complete blood count to screen for Hemolytic-Uremic Syndrome (HUS) None CT or MRI of the head if significant neurologic findings Drug and pregnancy testing in adolescents Hypertensive encephalopathy is a diagnosis of exclusion. Brain imaging is needed to rule out an intracranial mass or hemorrhage, which can be associated with high BP but require a different treatment approach than hypertensive encephalopathy. If the patient's hypertension has not previously been diagnosed or evaluated, other Evaluation of cause can be done later, after the patient is stabilized. 