Skip to main content

Hyperammonemia, Neonatal — History and Physical Exam — Clinical Pathway: Emergency Department and ICU

Neonatal Hyperammonemia Clinical Pathway — PICU and Emergency Department

History

FEN/GI
  • Decreased PO intake/prolonged fasting
  • Dehydration
  • Decreased UOP/wet diapers
  • Emesis
  • Abdominal discomfort
  • FTT, poor weight gain
  • Jaundice
ID
  • Fever
  • Symptoms suggestive of infection
  • Recent sick exposures
Neuro
  • Lethargy
  • Change in behavior or change from baseline
  • Neurodevelopmental delay
  • Hypotonia
  • Seizures
Respiratory
  • Central hyperventilation
  • Change in respirations
Hematologic
  • Bleeding
Miscellaneous
  • Recent anesthesia or surgical procedure

Physical Exam

Vital Signs
  • Temperature
  • Heart rate, blood pressure
  • Respiratory rate, pulse oximetry
Mental Status Neuro
  • Somnolent, lethargic, encephalopathic
  • Gestationally appropriate tone and reflexes
  • Response to exam, CN, motor exam, DTRs
HEENT
  • Anterior fontanelle full or bulging
  • Pupillary exam
Cardiac
  • Pulses, perfusion
Respiratory
  • Degree of work of breathing
  • Tachypnea
Skin
  • Jaundice
  • Bleeding (mucosal/petechial)
  • Pale
Infection Source
  • Recognizable viral or bacterial infection
  • Concern for sepsis

 

Jump back to top