endo Flashcards
normal range for plasma glucose
fasting 3.5-5.6
post prandial <7.8
diabetes diagnosis
oral glucose tolerance test
Fasting = ≥7.0mmol/L
Post OGTT = ≥11.1mmol/l
HbA1c = 48mmol (> 6.5%)
type 1 diabetes cause
t cell mediated destruction of pancreatic B cells
causes insulin deficiency and hyperglycaemia
type 1 diabetes presentation
polyuria
lethargy
polydipsia
weight loss
type 1 diabetes management and OD symptoms (and cure)
insulin weakness vomiting abdo pain give glucogel
diabetic ketoacidosis cause
prolonged insulin deficiency
diabetic ketoacidosis signs
confusion vomiting polyuria polydipsia weight loss abdo pain
diabetic ketoacidosis diagnosis
hyperglycaemia
acidosis
ketones in urine and blood >3
diabetic ketoacidosis management
correct dehydration - IV fluids
insulin - 1hr after fluids as can cause hypokalaemia
monitor electrolytes - K+
diabetic ketoacidosis fluids boluses weights maintenance insulin
correct over 48 hours boluses - 10ml/kg 0.9% NaCl <10kg 2ml/kg/hr 10-40kg 1ml/kg/hr >40kg 40ml/hr
When calculating the fluid requirement for children and young people with DKA, assume:
a 5% fluid deficit in mild to moderate DKA (indicated by a blood pH of 7.1 or above)
a 10% fluid deficit in severe DKA (indicated by a blood pH below 7.1).
maintenance + correction - %dehydration x 10 x kg
insulin - 0.1units/kg/hour (1hour after fluids)
diabetic ketoacidosis complications
cerebral oedema - decreased HR, increased BP and ICP, restless, irritable, falling consciousness
hypo signs
autonomic - irritable, hungry, nauseous
neuroglycopenic - dizzy, headache confusion, LOC
hypo managment
mild/moderate, severe
3-5 glucose tablets, if no improvement after 10mins repeat
Glucagon - s/c or i/m injection
if < 5 years = 0.5mg
if > 5 years = 1mg
Wait 10 minutes, when conscious give sugar
diabetic complications
retinopathy
nephropathy
neuropathy
hypothyroidism signs
prolonged neonatal jaundice poor feeding hypotonia dry skin/hair bradycardia constipation
hypothyroidism investigations
low T4
high TSH
hypothyroidism what is thyroid hormone important for
growth and neurological development
hypothyroidism management (+SE and managment)
levothyroxine - careful of thyroid storm (IV hydrocortisone, propanolol, fluids)
congenital adrenal hyperplasia cause
21-hydroxylase (for cortisol biosynthesis) deficiency
excess male steroids and low cortisol and aldosterone
congenital adrenal hyperplasia findings
cortisol deficient
increased ACTH
adrenal hyperplasia
increased progesterone leading to increased testosterone
21-hydroxylase needed for aldosterone production, as deficient get salt loss (low na, high k, metabolic acidosis)
congenital adrenal hyperplasia signs
vomiting
dehydration
ambiguous genitalia
precocius puberty
congenital adrenal hyperplasia managment
hydrocortisone for life (supress ACTH)
adrenocortical crisis signs
nausea/vomiting
abdo pain
lethargy
hypotension
adrenocortical crisis management
IV hydrocortisone - glucocorticoid
fludrocortisone - mineralocorticoid
androgen insuficiency syndrome presentation
x linked recessive
genetically male child with female phenotype
resistant to testosterone
undescended testes
breast development
androgen insuficiency syndrome management
counselling
bilateral orchidectomy - reduce risk of testicualr cancer
precocious puberty definition
development of 2nd sexual characteristics before 8 in females and before 9 in males
precocious puberty managment
synthetic GnRH analogues - supress pituitary gonadotrophins
no affect on androgen secretion so pubic hair still grows
treatment continued up to 11
