Endo/Metabolic/Nutrition

Question 1

CAH:

-how much hydrocort to give

Answer 1

25 mg , 50mg in larger children

Question 2

dehydration levels:

mild/mod/severe

what %, what ml/kg

Answer 2

mild: 3-5% 50ml /kg (dry mucus membranes)
mod: 6-9%, 100 ml/kg (cap refill <2 sec)
severe: >9%, 150 ml/kg (sunken fontanel, skin turgot, AMS)

Question 3

dehydration tx:

mild

mod

severe

Answer 3

mild: try ORT
goal: 50-100 ml/kg over 2-4h, start 5-10ml q5min

mod/severe: 20 ml/kg bolus to start

can also try subQ rehydratioin: 150U hyaluronidase with 22G angiocath into space between shoulder blades, with 20ml/kg/hr NS

Question 4

hyponatremia

-symptomatic treatment dose?

Answer 4

3% NS, 10ml/kg over 1 hour

Question 5

peds DKA

what is typical amount of fluid lost?

Answer 5

100ml /kg

Question 6

peds DKA criteria to dx

Answer 6

D: glucose >200

K: present. serum ketones is gold standard

A: ph <7.3 or HCO3 <15

Question 7

Peds DKA:

management: with doses

what kind of monitoring and labs at what intervals

Answer 7

1. 10ml/kg bolus (small!) over first 2h (up to 20ml/kg)
2. NS at 1.5-2x maintenance 4-6h
3. Add D5 for glucose 250-300
   insulin: 0.1 U/kg/h, no bolus

Hold insulin for K 3.3-3.5

monitoring: neuro exam q1h, glucose q1h, VBG q2h

Question 8

Peds DKA; cerebral edema

-what to look for, how to tx

Answer 8

1% of DKA episodes, occurs hours 4-12 usu

q1h neuro checks!

AMS, cushings triad, bradycardia

1. mannitol: 0.5-1g/kg over 20 min
2. hypertonic saline: 5-10 ml/kg/30min
3. restrict IVF to 2/3 maintenance

Question 9

IEM, if suspect

• what labs to get
• what to be careful about for transfer

Answer 9

think: acidosis, lactate, NH3, glucose, ketones

extra tubes for more tests inpatient

• pt may be very hypoglycemic for transfer, may need dextrose drip even possible central line
• ammonia may need dialysis

Question 10

IEM:

elevated NH3, how to tx

Answer 10

Can remove with:

1. Na benzoate/phenylacetate
2. dialysis

Question 11

Child with known IEM comes to ED

-how to manage

Answer 11

if elevated ketones or acidosis, if NH3 3x normal, unable to take PO,

provide: d10 1/4NS @ 1.5x maintenance until improved or for admission