endocrine disorders Flashcards
SIADH
-____ excess
-increased w___ a____
-decreased u___ o____
ADH
water absorption
urine output
Diabetes insipidus
-____ deficit
-decreased w___ a____
-increased u___ o____
-d____
-high s____
ADH
water absorption
urine output
dehydration
sodium
Cerebral salt wasting
-increased a____ n____ hormone
-u___ s____ excretion
-di____
-h____
-e____ or h_____
atrial natriuretic hormone
urine sodium
diuresis
hyponatremia
euvolemia
hypovolemia
SIADH management
–restrict ____
–restrict ____
–monitor __/___ and e____
–administer d___ use 0.9 % ___
sodium
fluids
I/Os and electrolytes
diuretics–NS
DI management
–administer v___ first then d___
–give f___ r____
–monitor f__ and e____
vasopressin
DDAVP
fluid replacement
fluid and electrolytes
DKA presentation
h____, k___ formation, l___ a___, g___ m___ a___
hyperglycemia
ketone
lactic acidosis
gap metaboic acidosis
Key DKA exam finding?
kusmmal respirations
DKA urine ketone diagnostic level is > ___ mmol/L
3
DKA management
1) __ mg/kg b____ (slow replacement)
2)__ x M___ in the first 24 hours
–then decrease to __-___ x m___
3) i___ infusion
—___ units/kg/hr
10 ml/kg bolus
2 X MIVF
—1-1.5 X MIVF
insulin
0.1 units/kg/hr
Once glucose in a child with DKA decreased to 250-300, add g____
glucose
DKA management
–use a 2-bag system, if glucose decreases faster than ___ dL/hr
100
In DKA replenish
p___ and p____
potassium
phosphorus
DKA management
–convert to SQ insulin once __ and ___ are normal
pH and HCO3
DKA cerebral edema presents with cushings triad = H____, b___, r__ d___
hypertension
bradycardia
respiratory depression
Assess for DKA cerebral edema with a ?
CT
DKA cerebral edema management
1)m____ __-__ gm/kg
2)__% h___ s____
mannitol 0.5-1gm/kg
3% hypertonic saline
adrenal insufficiency usually presents during times of s___
s/s include
h___, h___, we___, an____, __/___
stress
hypotension, hypoglycemia, weakness, anorexia, n/v
adrenal insufficiency management is with g____
glucocorticoids
adrenal crisis is rapid and overwhelming
It presents with
h____, fa____, vo____, mu___ pa___, an___, and we___ lo____
*management is with g_____
hypotension
fatigue
vomiting
muscle pain
anorexia
weight loss
–glucorticoids
What is the most common 21-hydroxylase deficiency?
co____ ad_____ h____
congenital adrenal hyperplasia
Congenital adrenal hyperplasia presents in newborns with
a___ g____, sa____ w___, sh____, decreased co____ and al_____
ambiguous genitalia
salt wasting
shock
cortisol and aldosterone
congenital adrenal hyperplasia lab findings include
h____
h____ and d_____
hyperkalemia
hyponatremia
dehydration
Congenital adrenal hyperplasia management
–administer f____
–give h______
fluids
hydrocortisone
Thyroid storm (due to untreated hyperthyroidism) is a life-threatening condition presenting with
h____, fe____, ta___, and sw_____
—-at biggest risk for c___ and pu___ ed____
hypertension
fever
tachycardia
sweating
CHF
pulmonary edema
Hyperthyroidism and thyroiditis treatment is with
P___ and. me____
PTU (propylthiourcacil)
methimazole
Hypothyroidism is often associated with other disorders such as
t____
d___ and
a______ disease
trisomy 21
diabetes
autoimmune disorders
in hypothyroidism
T4 will be
and
TSH will be
low
high
Sick euthyroid occurs during times of critical illness
management is s____
supportive
–resolves once critical illness passes
polyhydramnios is associated with c___ a____ and s_____
congenital anomalies
syndromes
oligohydramnios is associated with I____
IUGR
What is the leading cause of deafness and blindness?
C_____ s___
CHARGE syndrome
–autosomal dominant
—CDH7 mutation
C___ of the e____
H____ defects
A___ of n____
R_____ of growth and development
G_____ abnormalities
E___ abnormalities/d___
coloboma of eye
heart defects
atresia of nares
retardation
genitourinary
ear/deafness
Adolescents with CHARGE syndrome may require _____ replacements
hormone
Children with Trisomy 21 are at increased risk for a___-a____ i____ leading to s___ c___ i____
—-for symptomatic kids obtain c__ r___
atlantoaxial instability
spinal cord injury
cervical radiographs
50% of children with down syndrome will have a____ v____ c____ defects
atrial ventricular canal defects
turner syndrome most commonly affects?
girls
–will have a normal lifespan
Turner syndrome is associated with
*in_____
*h___ and v____ problems
*co____ of a____
*ho___ ki_____
*ly_____ in babies
infertility
hearing and vision
coarctation of aorta
horseshoe kidneys
lymphedema
What is the most common form of inherited intellectual disability?
Fragile X
–will have a normal lifespan
–Begin behavioral therapy early
Trisomy 18 (Edwards)
*____ predominance
*profound i___ d____
*managed with p___ c___ and/or h____
female
intellectual disability
Palliative care and/or hospice
—50% are stillborn
—-10% dont survive past 1 YOA
Achondroplasia (dwarfism)
**monitor for s___ deformities
**managed h____
**monitor for o___
spinal
hydrocephalus
OSA
Marfan syndrome is a connective tissue disorder, these children are at high risk for
**ao___ di____
**re___ de____
**sp___ pn_____
aortic dilation
retinal detachment
spontaneous pneumothorax
Marfan syndrome management
**b__ b___ therapy
**e___ restriction
**serial E____
beta-blocker therapy
exercise restriction
serial ECHOs
22q112 deletion =
DiGeorge syndrome
–delayed
–low ears absent kidneys
–conductive hearing loss prone
Children with DiGeorge syndrome (velocardiofacial syndrome) are at greatest risk for
**i______
**h_____
immunodeficiency
–low T-cell
hypocalcemia
—need daily calcium
DiGeorge syndrome management
**c____ administration
**monitor for recurrent r___ i__
**@ 4 YOA begin c__/s___ f___
calcitrol
respiratory infections
cervial/spinal films
What is the first clue of Vacterl syndrome diagnosis?
si____ u____ a____
single umbilical artery
Williams syndrome is associated with
**se__ defects
**h___
**st___ ir____
septal defects
–Cardiac involvement determines life expectancy
hyperkalemia
starburst irisi
Dog, cat, human bite management
**first-line outpatient =a ____
**first line inpatient= =a____-su____
augmentin
ampicillin-sulbactam
Snakebite management
**a____ if indicated
**t____ v____ administration
anti-venom
tetanus vaccine
Brown recluse spider bite
—ongoing monitoring for the development of t___ n____
tissue necrosis
black widow bite management
—acute p____
–obtain c___ studies and an E___
pain
coagulation
EKG
Necrotizing fascitis organisms include?
group a strep and staph
—severe toxic appearance with skin edema (monitor for compartment syndrome)
Stevens-Johnson (erythema multiform) is characterized by b___ and f____
blistering and fever
What medications most often cause Stevens-Johnson (erythema multiform)
an_____
su___
au____
ba___
N____
antiepileptics
sulfonamides
augmentin
bactrim
NSAIDs
Stevens-Johnson (erythema multiform) management
*p___ control
*bl___ prevention
pain control
blindness
bullous impetigo treatment
–au____ + ce____
augmentin
cephalosporins
—large blisters in armpit, groin, fingers, toes
UTI txt
1)b___
2)c___ (k___)
bactrim
keflex
Pyelonephritis
–identify the organism in. the b____
–monitor for r___ s____
bloodstream
renal scarring
Testicular torsion diagnostic test is via an _____
ultrasound
Males with testicular torsion present with
s___ onset of p___ in one t____
sudden onset of pain in one teste
—surgical emergency
ovarian torsion also an emergency
renal tubular acidosis =
m___ a____ + n___ a___ g___
metabolic acidosis
normal anion gap
renal tubular acidosis management
**replace b____
bicarb
-Prevent renal failure
What is the most common type of renal failure?
pre-renal failure
–seen in trauma and shock
–reversible
intrinsic renal failure labs
–elevated c___, p___, u__ a___
calcium
phosphorus
uric acid
nephrotoxic medications
g____
a_____
gentamycin
acyclovir
postrenal failure is due to o___ t___ o____
outflow tract obstruction
–anything that obstructs kidneys
Indications for dialysis include
h____
severe f___ o___
a____
hyperkalemia
fluid overload
azotemia
Nephrotic syndrome presents with a___ and p_____
albuminuria
proteinuria
Txt nephrotic syndrome with?
corticosteroids
Nephrotic syndrome s/s
e___
we___ g___
fl___ r____
pr____
fa____
edema
weight gain
fluid retention
proteinuria
fatigue
HIV testing requires?
parental consent
To determine risk for opportunistic infections in HIV + children, obtain c___ measurements
CD4
—vaccinate during high CD4 counts
JIA is diagnosed when arthritis s/s are present for > ___ weeks
6
In a child with JIA, what lab determines uveitis risk?
+ ANA
First line JIA management is with?
NSAIDs
followed by steroids
The risk for SLE increases in?
adolescent females
Kawasaki imaging
-obtain an?
ECHO
In a child with Kawasaki
obtain an EchO at time of diagnosis
–__ weeks post dxs and
–_-__ weeks posts dxs
2
6-8
evaluate for cardiomegaly with a?
chest x-ray
Kawasaki management
1) I___
2) A____
IVIG
Aspirin
Initial Kawasaki aspirin dosing is
__-__ mg/kg/day
–Once afebrile decrease aspirin dosing to
__-__ mg/kg/day for __-__ weks
80-100 mg/kg/day
3-5 mg/kg/day
6-8 weeks
In a child with Kawasaki, aspirin is continued indefinitely if c___ a____ abnormalities are present
coronary artery
GI decontamination activated charcoal dose
__ g/kg
—Repeat doses are dosed at
__ g/kg
1 gm/kg
0.5 g/kg
–contraindicated if the airway unprotected or it pt has an abnormal gi tract
Whole bowel irrigation = m___ or g___ administration
miralax or golytley
-contraindicated for obstruction or perforation
Whole bowel irrigation is used for
i___ tablet ingestion
po____ ingestion
li___ ingestion
iron
potassium
lithium
Alcohol/ethanol ingestion impairs g____
-children may become h___ as far at __ hours post ingestion
gluconeogenesis
hypoglycemic
6
facial flushing, vomiting, diaphoresis, hypotension, hypothermia, hypoglycemia, lethargy, slurred speech, ataxia, seizures, respiratory depression, stupor, coma = a____/____ ingestion
alcohol/ethanol
ingestion
ethylene glycol ingestion (antifreeze)
complications may occur __-___ hours post ingestion
6-12
ethylene glycol ingestion (antifreeze) complications
a___ g___ m___ a____
re___ t___ i____
h_____
anion gap metabolic acidosis
renal tubular injuries
hypocalcemia
In a child with ethylene glycol ingestion (antifreeze)
GIVE
-____ or et____
4MP
ethanol
Treat a child with ethylene glycol ingestion (antifreeze) with dialysis when ethylene glycol level is > ____mg/dL or if the patient is refractor to txt
50
isopropyl ingestion (found in rubbing alcohol) had no antidote.
When IPA level is > ____ mg/dL begin dialysis
500
Methanol (found in antifreeze, paint strippers)
antidote =
fo____ or et____
fomepizole
ethanol
Kids with tylenol ingestion recover within __-__ days s/p ingestion
5-7
Acetaminophen overdose
**> _____ mg/kg in kids less than 6 YOA
**___ gm in teens
200
10g
The Tylenol antidote N-acetylcysteine is most effective is given within ___ hours of ingestion
TXT regimens
1) ___ hours of oral therapy
2)___ hours of IV therapy
8
72
21
salicylate ingestion s/s
ti____ + ar____
tinnitus
arrhythmias
Refer a child with salicylate ingestion to ER if
> ___ mg/kg or ___ grams of aspirin was ingested
> 150
65
iron ingestion toxicity s/s
–within __ hours, children develop
__/__/__, and b__ s___
6
n/v/d
bloody stools
iron toxicity likely when
> ___-___ mg/kg is ingested
40-60 mg/kg
Iron ingestion management
–o___ l___ within 1 hour
orogastric lavage
iron antidote =
deferoxamine
opiod ingestion s/s triad
c___ depression, r___ depression, m___
CNS
respiratory
miosis
organophosphate (insecticide) ingestion txt
pra____ ch___ and at____
pralidoxime` chloride
atropine
beta blocker ingestion is fatal due to decreased?
contractility
