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Pediatrics, Respiratory Distress Syndrome: Differential Diagnoses & Workup
Updated: Sep 18, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Differential Diagnoses
Other Problems to Be Considered
Oxygen toxicity
Ventilator-induced lung injury
Decreased capillary oncotic pressure
Neurogenic pulmonary edema
Postobstructive pulmonary edema (due to increased negative interstitial pressure)
Fat embolism
Workup
Laboratory Studies
- Suggested laboratory tests include blood gas, CBC with differential, and electrolyte panel with BUN and creatinine. An arterial blood gas may be the most appropriate laboratory test to obtain and would be necessary if calculating the Pa2/FiO2 ratio for ALI/ARDS criteria. However, given the time course of the disease process, Pa2/FiO2 criteria is less likely to be met during the early disease course in the ED setting. A CBC may indicate an infectious etiology as well as uncover significant anemia, which will further compromise oxygen-carrying capacity. An electrolyte panel may also screen intravascular volume status, anion gap acidosis, and other potential comorbidities. Additional laboratory tests would be indicated pending specific concerns toward individual patients.
- The onset of capillary congestion and changes in the alveolar epithelium during the initial exudative stage leads to significant V/Q mismatching and intrapulmonary shunting. During this stage of ARDS, oxygen diffusion is impeded much greater than carbon dioxide diffusion, which is attributed to the much greater solubility of carbon dioxide. Therefore, hypoxemia tends to be a predominant laboratory finding with either a normal or low PCO2.
- Arterial blood gas measurements reveal hypoxemia refractory to supplemental oxygen.
Imaging Studies
- The radiologic findings in ARDS are nonspecific (see Media file 1, Media file 3). Radiographic findings immediately after the inciting event may be entirely normal or may show only the primary disease process.
- Subsequently, progressive bilateral interstitial and alveolar infiltrates develop without cardiomegaly (see Media file 2, Media files 4-6).
A 14-month-old boy with a diagnosis of exacerbation of bronchopulmonary dysplasia (BPD). Chest radiograph on the day of admission.
A 14-month-old boy with bronchopulmonary dysplasia (BPD) exacerbation and impending respiratory failure. Chest radiograph on day 2 in the morning.
A 14-month-old boy with bronchopulmonary dysplasia (BPD) exacerbation and respiratory failure. Chest radiograph on day 2 in the afternoon.
A 14-month-old boy with bronchopulmonary dysplasia (BPD) exacerbation, respiratory failure, and severe hypoxemia. Chest radiograph on day 2 in the evening.
- CT in ARDS, while not a routine part of the evaluation of children with ARDS, reveals most of the infiltrates in the dependent regions of the lung.
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Differential Diagnoses & Workup: Pediatrics, Respiratory Distress Syndrome |
| Treatment & Medication: Pediatrics, Respiratory Distress Syndrome |
| Follow-up: Pediatrics, Respiratory Distress Syndrome |
| Multimedia: Pediatrics, Respiratory Distress Syndrome |
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References
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Further Reading
Keywords
acute respiratory distress syndrome, ARDS, severe acute respiratory syndrome, SARS, acute lung injury, ALI, multiple organ failure syndrome, MOFS, respiratory distress syndrome in children












Differential Diagnoses & Workup: Pediatrics, Respiratory Distress Syndrome