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Paediatrics > 1: Endocrine - DKA, T1DM, T2DM, MODY > Flashcards

1: Endocrine - DKA, T1DM, T2DM, MODY Flashcards

1
Q

What is the criteria for DKA in children

A

Acidosis:

  • Bicarbonate >15
  • pH <7.3

Ketonaemia:

  • Serum ketones >3
  • Urine ketones: ++
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2
Q

What type of diabetes occurs in children

A

T1DM

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3
Q

What is a method to remember triggers of T2DM

A

5I’s

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4
Q

What are 5 triggers of diabetes mellitus

A 
Infection 
Intercurrent illness 
Intoxication 
Infarction 
Insulin withdrawal
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5
Q

What are 5 symptoms of diabetes mellitus

A
  • Abdominal pain
  • Nausea and vomiting
  • Kussmaul breathing - with acetone breath
  • Dehydration
  • Reduced consciousness
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6
Q

What should happen to a child with blood-glucose >15 and symptoms DKA

A

Refer to paediatric acute assessment unit

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7
Q

when should a child with known diabetes be referred for DKA assessment

A

Measure capillary glucose if:

  • Polydipsia
  • Polyuria
  • Excessive fatigue
  • Tiredness

and symptoms DKA

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8
Q

what defines mild dehydration in DKA

A

3% weight-loss

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9
Q

what defines moderate dehydration in DKA

A

5%. weight-loss, reduced skin tutor, dry mucous membranes

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10
Q

what defines severe dehydration in DKA

A

8% weight-loss
Sunken-eyes
Reduced capillary refill

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11
Q

Explain DKA

A
  • Absence of insulin causes lipolysis
  • FFA produced enter ketongenesis to form ketone bodies
  • Ketones reduce pH of blood causing metabolic acidosis
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12
Q

What investigations are required for diagnosis of DKA

A
  • Capillary blood-glucose
  • Serum ketones (B-hydroxybuterate) or urinary ketones
  • Venous blood gas
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13
Q

What are criteria for admitting DKA patient to HDU

A
  • Under 2-years

- pH <7. 1

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14
Q

What is first-line for management for DKA

A

Fluid resuscitation

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15
Q

How should fluid be replaced and why

A

Replace fluids over 48h, any quicker than this increases risk of cerebral oedema

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16
Q

What time-frame should resuscitation fluid be replaced in cerebral oedema

A

48 hours

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17
Q

How is ‘maintenance fluid’ calculated in DKA

A

(Maintenance + Fluid Deficit)/48

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18
Q

What is fluid deficit for mild DKA

A

5%

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19
Q

What is fluid deficit for moderate DKA

A

10%

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20
Q

What should be added to maintenance fluid in DKA

A

KCl (Potassium) 20mmol/500ml

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21
Q

When is insulin given in DKA

A

1h after fluids started

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22
Q

Why is insulin not given earlier than one-hour

A

Increases risk of cerebral oedema

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23
Q

What insulin is given

A

Actarapid 0.1 unit/Kg/h

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24
Q

What is done when glucose drops below 14

A

Continue 5% dextrose and insulin

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25
Q

When is IV insulin stopped in DKA

A

Ketones less-than 1 and can tolerate oral food

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26
Q

In which population does cerebral oedema only tend occur

A

Children with DKA

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27
Q

What are 5-symptoms of DKA

A
  • Drop in HR
  • Increase in BP
  • Headache
  • Agitation
  • Oculomotor palsy
  • Unequal pupils
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28
Q

How is cerebral oedema in DKA managed

A

20% Mannitol

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29
Q

What is T1DM

A

Autoimmune condition caused by production autoantibodies to B-islet cells

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30
Q

What age does T1DM tend to present

A

5-7 years and prior to adolescence

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31
Q

What is a risk factor for T1DM

A

FH

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32
Q

Explain symptoms of T1DM

A
  • Polyuria
  • Polydipsia
  • Lethargy
  • Nocturnal enuresis
  • Weight loss
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33
Q

What is a common symptom of T1DM in children

A

Nocturnal enuresis

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34
Q

How may T1DM present

A

DKA

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35
Q

How soon should a child with suspected T1DM be seen in secondary care

A

If suspect a child to have T1DM requires same-day referral to paediatric diabetes team

36
Q

What is the diagnostic criteria for T1DM

A

Child with symptoms requires one-of:

  • Fasting plasma glucose >7
  • Random plasma glucose > 11.1
  • OGTT > 11.1
37
Q

If no symptoms, what is the diagnostic criteria for T1DM

A

Requires two of:

  • Fasting plasma glucose >7
  • Random plasma glucose > 11.1
  • OGTT > 11.1
38
Q

What value of fasting plasma glucose diagnoses T1DM

A

> 7

39
Q

What value of OGTT and RPG diagnoses T1DM

A

> 11.1

40
Q

What test is not appropriate for diabetes in young-people

A

HbA1c = it is NOT used to diagnose T1DM or young-people

41
Q

Explain use of C-peptide to diagnose T1DM

A

C-peptide should not be used in the first instance to diagnose T1DM

42
Q

What is conservative management for T1DM

A

Advice on:

  • Diet and exercise (dietician)
  • Taking insulin
  • Sick day rules
  • Monitoring BG
43
Q

How often should a child with T1DM have dental exams

A

Regularly

44
Q

How often should a child with T1DM have dental reviews

A

2-years

45
Q

What vaccines should all individuals with T1DM be offered

A

Pneumococcal

Annual Influenza

46
Q

If someone is ill, how often should they monitor their blood glucose

A

4-hrly

47
Q

What are the sick day rules for T1DM

A

Continue taking insulin

48
Q

Why should insulin NOT be stopped if ill

A

Illness increases glucocorticoids, which increases blood-glucose. If stopped can precipitate DKA

49
Q

How is T1DM managed

A

Insulin

50
Q

What are the three three insulin regimens for T1DM

A
  • Mixed daily bolus regimen
  • Novomix
  • Continuous SC insulin
51
Q

Explain multiply-daily basal bolus insulin regimen

A
  • Short-acting insulin is given TDS 1h prior to meals

- Long-acting insulin is given once

52
Q

Explain second insulin regimen

A

Novomix (Intermediate acting insulin) given twice a day

53
Q

What is continuous subcutaneous insulin

A

A pump is fitted that gives continuous SC insulin

54
Q

When is continuous SC insulin recommended

A

Children and adults over 12-years

55
Q

What regimen is offered first to children with T1DM

A

Multiple daily-dose basal bolus regimen

56
Q

What are insulin requirements in childhood

A

0.5 Units/Kg

57
Q

What are insulin requirements in puberty

A

1.2- 2.0 Units/Kg

58
Q

What are insulin requirements post- puberty

A

0.7 - 1.2

59
Q

What 4 things do children with T1DM need to be monitored for

A
  1. Thyroid disease
  2. Diabetic retinopathy
  3. A:Cr
  4. HTN
60
Q

When does monitoring for thyroid disease occur

A

Diagnosis until adult care

61
Q

What does monitoring for A:Cr, diabetic retinopathy and HTN occur in T1DM

A

> 12-years

62
Q

What are 3 acute-complications of T1DM

A
  1. Hypoglycaemia
  2. DKA
  3. Delayed puberty
63
Q

Explain microvascular complications

A

Can occur in childhood and adolescence. But, rare to occur before puberty

64
Q

What are microvascular complications

A

Renal: Diabetic nephropathy, microalbuminaemia

Eyes: Diabetic Retinopathy

NS: Peripheral Neuropathy, Autonomia Neuropathy

65
Q

What are mascrovascular complications of diabetes

A

CHD

Stroke

66
Q

What 3 conditions are associated with T1DM

A
  1. Thyroid
  2. Coeliac
  3. Addison’s
67
Q

What is T2DM

A

Condition due to peripheral tissue insulin resistance

68
Q

Explain age T2DM tends to present in

A
  • Rare to present in children. However, it is increasing due to obesity epidemic
69
Q

What are 3 risk-factors for T2DM

A

Obesity
FH
Asian or Afro-carribean

70
Q

Explain identifying T2DM symptoms in young-patient

A

If symptoms present in young patient, assume T1DM unless strong indicators otherwise:

  • FH T2DM
  • Features to suggest insulin resistance (acanthosis nigricans)
  • Obese
  • Asian or Afro-carribean
  • No insulin requirement after remission phase
71
Q

What are 5-features that will make you strongly consider this is T2DM

A
  1. Obese
  2. Asian or Afro-Carribean
  3. Strong family history T2DM
  4. Features insulin resistance (acanthosis nigricans)
  5. No insulin requirement following remission phase
72
Q

Explain conservative management

A

Diet and exercise
Weight loss if obese
Influenza and pneumococcal vaccine

73
Q

What is first-line medical management for T2DM

A

Metformin

74
Q

Define MODY

A

Onset of T2DM in individuals before age 25

75
Q

Which age defines limit for MODY

A

Less than 25

76
Q

Explain ‘clinical presentation of someone with MODY’

A

Symptoms diabetes
Less than 25
Often strong FH
No ketosis at presentation

77
Q

What is the most common type of MODY

A

MODY 3

78
Q

What gene is mutated in MODY3

A

HNF1a

79
Q

When does MODY-3 present

A

Adolescence

80
Q

What does MODY3 increase risk of

A

Hepatocellular carcinoma

81
Q

What is the second most-common type of MODY

A

MODY 2

82
Q

What is mutated in MODY 2

A

Glucokinase

83
Q

When does MODY 2 present

A

Early childhood

84
Q

What is the prevalence of MODY 5

A

Rare

85
Q

When does MODY 5 occur

A

Post-Puebertal

86
Q

What is MODY 5 associated with

A

Liver and Renal Cysts

87
Q

What are MODY treated with

A

Sulphonylureas

Paediatrics (61 decks)

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