Tachycardia Unresponsive to Crystalloid Bolus

Abstract

Dehydration is a common complaint in the pediatric emergency department. The treatment is typically focused on oral or intravenous rehydration with the goal of normalization of vital signs, primarily the heart rate but potentially also the blood pressure. The failure of routine therapy may lead to the consideration of other etiologies, including potential chronic conditions. We present a unique case of a twenty-three-month-old female who initially presented to the pediatric emergency department with signs of dehydration secondary to vomiting and diarrhea as well as tachycardia that did not improve with fluid resuscitation. Although physical examination findings were subtle, laboratory testing later confirmed the diagnosis of thyrotoxicosis. She was started on treatment with atenolol and methimazole. This case describes thyroid disease in a young child without a history of maternal autoimmune illness, which is rarely diagnosed in the emergent department. Healthcare providers should be cognizant of the spectrum of clinical findings in pediatric hyperthyroidism, since the early recognition and treatment is crucial for improved outcomes with this life-threatening pediatric condition. We discuss the consequences of undiagnosed Grave’s disease and review common findings that can assist with early diagnosis in the emergency department.