5.1 Endocrine Emergencies Paeds

Question 1

What bloods to get when someone is hypo?

Answer 1

Glucose, Ketones
FFA, ketones
Lactate, pyruvate
Cortisol, GH
LFTs
Carnitine
Ammonia

Question 2

What urine to get when someone hypoglycaemic?

Answer 2

Ketones
Metabolic screen for organic acids
Amino acids
Galactosuria

Question 3

If no FFAs then there’s no?

Answer 3

Ketones

Get non-ketotic hypoglycaemia

Question 4

What causes non-ketotic hypoglycaemia?

Answer 4

Hyperinsulinism

Question 5

What causes ketotic hypoglycaemia?

Answer 5

Low glucose and low insulin, frees up FFA and ketones get made

Question 6

How to treat mild-mod hypos?

Answer 6

• 10-15g of fast acting CHO (200ml juice. 4 large jelly beans)
• 1 slice bread/biscuits/fruit/milk

Question 7

Severe hypos treatment?

Answer 7

IV dextrose infusion
2ml/kg 10% dextrose
Then
5-10% dextrose to maintain above 4mmol/l

• review food plan
• DM review

Question 8

Treatment of diabetic ketoacidosis:

Answer 8

1. Admit to hospital
2. Treat shock with fluid bolts: 10ml/kg
   - O2 with NP
3. Rehydrate over 24-48 hours
4. Rehydrate with N.saline unless calculated hypernataemia

Question 9

What to avoid in diabetic ketoacidosis?

Answer 9

Sodium bicarb

Question 10

Insulin infusion rate for diabetic ketoacidosis?

Answer 10

0.075-0.1units/kg/hour after rests.

Question 11

In diabetic ketoacidosis, aim for BGL fall of how much per hour?

Answer 11

5mmol/hour

Question 12

How to treat cerebral oedema?

Answer 12

Mannitol 0.5-1g/kg IV over 20 minutes

Reduce IV fluids

Question 13

Acute adrenal insufficiency, what happens?

Answer 13

Cortisol deficiency
Loss of vast motor tone
Hypoglycaemia
Shock

Question 14

Aldosterone deficiency results in?

Answer 14

Less Na+
Hyperkalaemia
Acidosis
Dehydration: shock

Question 15

What is secondary adrenal insufficiency?

Answer 15

Central
Hypothalamic
Pituitary
-exogenous glucocorticosteroids

Question 16

How to treat acute adrenal insufficiency?

Answer 16

IV hydrocortisone
100mg/m2
Or IM at home

Question 17

What is stress dosing for hydrocortisone for mildly unwell

Answer 17

3x normal dose and give 6-8 hourly

Question 18

What is stress dosing for hydrocortisone for more unwell or temp >39

Answer 18

Increase hydrocortisone to 4x and give 6 hourly

Question 19

What is diabetes insipidus?

Answer 19

Hypernatraemia

Excess dilute urine

Question 20

3 main types of Diabetes insipidus?

Answer 20

Central/hypothalamic
Nephrogenic
Primary polydipsia

Question 21

Risk factors for diabetes insipidus?

Answer 21

Large intrasellar masses
Tumours: craniopharyngioma/Rathke/ACTH secreting tumours
Young
Males

Question 22

Treatment of Diabetes insipidus?

Answer 22

Fluid balance, monitor electrolytes
Maintain electrolytes
Desmopressin

Question 23

What is cerebral salt wasting?

Answer 23

• Tumours/trauma causes release of BNP and causes diuresis

- hyponatraemic dehydration

Question 24

What are the renal effects of BNP?

Answer 24

• Glomerulus: increases GFR and Na+ excretion
• inhibits NA reabsorption in tubules
• inhibits reabsorption of free water

Question 25

Endocrine effects of BNP?

Answer 25

Inhibits renin and therefore aldosterone

Inhibits ADH—>diuresis

Question 26

What do you do with
Fluid
Sodium
Adjunct
In cerebral salt wasting?

Answer 26

Fluid: replace
Sodium: replace
Adjunct: Fludrocortisone

Question 27

What do you do with
Fluid
Sodium
Adjunct
In SIADH?

Answer 27

Fluid: Restrict
Sodium: Normal

Question 28

What do you do with
Fluid
Sodium
Adjunct
In Diabetes Insipidus?

Answer 28

Fluid: replace
Sodium: normal
Adjunct: DDAVP

Question 29

How to manage thyroid storm?

Answer 29

Potassium iodide blockers
Cabimazole,
PTU
IV fluids
Beta blockers
Dexamethasone
Paracetamol
Cooling