Safety considerations during endocrine/metabolic tests in children
Any dynamic or provocative test has potential for side effects or adverse reactions, although these are uncommon in experienced hands and if appropriate precautions are taken. Precautions, contraindications and adverse reactions are indicated in the protocols for each test and should be reviewed before each test is undertaken. Important adverse reactions in various tests include:
- Minor reactions to provocative agents eg. nausea, vomiting
- Allergic or anaphylactic reaction to provocative agent
- Cannula related complications - blood loss, infection
To minimize potential adverse events the following should be considered:
- Tests on children should only be performed and supervised in specialised paediatric endocrine centres.
- Staff must have detailed knowledge of the particular test protocol and provocative agents.
- Specialised nursing staff familiar with these tests are essential if they are to be performed safely and give accurate results.
- Tests must be performed in an environment where full paediatric emergency resuscitation facilities and experience are available. Deaths and serious morbidity have been reported from such testing in inexperienced hands (Shah, Stanhope, Matthew. Hazards of pharmacological tests of growth hormone secretion in childhood. BMJ 1992;304: 173-4).
- It may be necessary to adjust protocols for particular individuals or circumstances, and the same protocol cannot automatically be safely applied to all patients. Prior to the test, consideration should be given to any particular customisation or precautions required for the individual patient (see guidelines under individual tests). This should be discussed with the consultant concerned.
- Appropriate laboratory back-up is essential, particularly for tests involving fasting, hypoglycaemia or water deprivation. Facilities are required for immediate formal glucose monitoring in the testing ward.
- A medical officer must always be readily available, and in certain tests eg insulin stimulation test, must be immediately available in the ward.
- Experienced personnel are required to site intravenous cannulae.