Endocrine Flashcards
phenylketonuria (PKU)
Absence of phenoalanine hydroxylase enzyme
dx PKU
Newborn screening’s
tx PKU
diet free in Meat, Limited fruits/veggies and grains
phenylalanine free formula
breast feed
Galactosemia
Lack of enzyme that converts galactose to glucose
Lactose intolerant
tx galactosemia
Lactose free diet
Soy formula
Calcium supplements
No breast-feeding
which medication should you be cautious in taking with galactosemia?
Penicillin
Some vitamins
what is the number one concern with hypothyroidism
Airway protection
tx hypothyroidism
Oral thyroid hormone replacement for life
Synthroid
med. Administration precautions.
Avoid heat exposure
Don’t mix with soy formula
treatment for hyperthyroidism
propylthiouracil
Subtotal thyroidectomy
High calorie diet
Limit activities/stress
what is a complication from PTU
agranulocytosis/leukopenia
Sore throat and fever
what should be done with agranulocytosis?
Placed in isolation and start antibiotics
where does the growth hormone deficiency condition occur?
Anterior pituitary
Hypofunction
sx growth hormone deficiency
skeletal proportions are normal for age
Retarded bone age
tx growth hormone deficiency
Daily sub Q injection’s
very expensive
Cortisone
when should the injections be taken throughout the day?
At night
Mimics natural tendency
Will children be giants after growth hormone injections
No, reassure parents
precocious puberty
Before nine in boys
Before eight in girls
True precocious puberty
normal puberty but earlier
pseudo, precocious puberty
Thelarche – early breast
Pubarche – early pubic, under arm hair
Menarche - period
what is the treatment for precocious puberty?
Monthly injection of Lupron
Take until normal age of starting puberty
congenital, adrenal hyperplasia
Overproduction of adrenal androgens
Decreased production of cortisol and aldosterone
sx of CAH in males
Precocious genitalia development
sx CAH in females
Ambiguous genitalia
sx of both gender for CAH
decrease stress response
Hypoglycemia
Hyponatremic, dehydration
Increased inflammatory response
Hypo tension
Salt tasting skin
treatment for CAH
Lifelong Cortizone injections
Reconstructive surgery
type one diabetes
Body doesn’t produce insulin
Auto immune destruction of pancreatic beta cells
type 2 DM symptoms in children
Weight gain
Fatigue
Frequent infections. – yeast
acanthosis nigrocans – leathery patch in body folds
can type one diabetic children eat any type of carbs as long as they replace with insulin?
Yes, no restrictions
Try to avoid high sugar
carb free sources
Meat
Cheese
Sugar, free options
Rapid insulin
Lispro, aspart
Onset 15 minutes
Peak one hour
Duration 3 to 4 hours
Long acting insulin
Glargine
onset 4 to 6 hours
No peak
Lasts 24 hours
when to monitor blood glucose
Before meals
Bedtime
Sick
Before exercise
when to monitor urine ketones
Blood glucose greater than 240 on two separate occasions
Pump therapy greater than 240 on any occasion
DM management with toddlers
differentiate between misbehavior
Report funny feeling
Food jags expected/refusal
Give choices
DM management with preschoolers
Reassure not a punishment
Participate in simple tasks
Report Lows and what to eat then
DM management with school-age
Educate personnel
Encourage independence and continuation in clubs and exercise
All activities supervised
DM management with adolescents
Self-care
More willing to inject
Continued parental support
what to teach with adolescents drinking alcohol
Eat while drinking
should you continue to give insulin as scheduled on a sick day?
Yes, check glucose before eating
hypoglycemia
Blood sugar less than 60
Hunger, headache
Confusion, shaky, dizzy
Sweating
rule of 15
15 g of fast acting carbs recheck in 15 minutes
severe hypoglycemia treatment
Patient is unable to swallow
Glucagon 1 mg sub Q/IM
Place on side
options for rule of 15
Honey
Skittles
One half cup juice
One cup milk – white
Cake icing
hyperglycemia
Blood glucose greater than 180
Increased thirst
Frequent urination
should you give diabetic patients caffeinated fluids for hyperglycemia?
No
DKA
access ketone bodies from fat metabolism
Blood glucose greater than 300
what is the most serious symptom with DKA?
Cerebral edema leads to death
treatment for DKA
1st hour: Fluids, NS
2nd hour: add electrolytes and start
Insulin drip and continue Observation
how to control descent
Don’t drop blood sugar lower than 52, 100 per hour
What to do after blood glucose reaches 250 to 300
Add dextrose, and half normal saline to insulin drip
when is the child able to eat throughout this resuscitation?
Anytime as long as they are tolerating it
how to know when DKA is resolved
PH and anion gap are within normal limits
Patient is able to eat and drink
When to discontinue insulin drip
patient tolerates oral fluids
Sub Q insulin administration
