Endocrine emergencies Flashcards
Most common endocrine emergency
Hypoglycemia
Kids are so susceptible because of: Increased metabolic demands Need for constant glucose source for brain development Small glycogen stores Fewer gluconeogenesis precursors
Most common cause of hyperthyroidism in kids
Graves
Presenting symptoms of hyperthyroidism
Palpitations Sinus tachycardia School difficulties Labile emotions Hyperactivity New onset psychiatric symptoms
Symptoms of a thyroid storm
Fever Sweating Tachycardia Hypertension Agitation Confusion N/V
3 main systems
CVS
GI
CNS
Treatment of thyroid storm
Supportive care O2 IVF - Dextrose containing IV Beta-blocker Routine hyperthyroid Tx - Methimazole, propylthiouracil, iodine
Symptoms of congenital hypothyroidism
present at 6-12 weeks (if not caught by neonatal screen)
Constipation Large posterior fontanelle Poor feeding Hypotonia Jaundice Hypothermia
Neonatal hyperthyroid symptoms
Present with neonatal thyrotoxicosis First 2 weeks of life Irritability Sweating Weight loss Poor feeding Vomiting Diarrhea Exophthalmos Goiter Hyperthermia Tachycardia Jaundice Hepatomegaly Cardiac failure
Sx of acute adrenal insufficiency
Dehydration with hypovolemic shock Profound hypoglycemia Hyponatremia Hyperkalemia Hypotension Abdominal pain Altered LOC
Triggered by infection or other physiologic stressor (trauma, surgery etc.)
Other classic signs for adrenal crisis in CAH- ambiguous genitalia in a female, hyperpigmented scrotum in a male
2-5 weeks of life
Emergency treatment for acute adrenal insufficiency
ABCD
Correction of hypoglycemia
Stat stress steroids - Hydrocortisone IV/IM
Fluid resuscitation
Monitoring VS, cardiac, resp, perfusion, glucose, electrolytes
Correct electrolyte abnormalities:
- Hyperkalemia - Sodium polystyrene sulfonate, glucose/insulin, calcium gluconate, sodium bicarbonate
Initial labs: Random cortisol levels Electrolytes Glucose ACTH levels (adrenocorticotropic hormone) Plasma renin activity Aldosterone level Urine electrolytes
Most common form of congenital adrenal hyperplasia (CAH) and incidence
21-hydroxylase deficiency
95% of all cases
Salt-wasting in 30-70%of cases
Incidence is 1 in 10,000-20,000
Presenting symptoms of salt-wasting CAH
Ambiguous genitalia in a female
Hyperpigmented scrotum in a male
2-5 weeks of life
Nonspecific signs mimicking sepsis: Dehydration with hypovolemic shock Profound hypoglycemia Hyponatremia Hyperkalemia Hypotension Abdominal pain Altered LOC Poor feeding Lethargy Poor weight gain Irritability Vomiting
Metabolic acidosis, hyponatremia, hyperkalemia
Treatment of salt-wasting CAH
ABCD - check glucose
IVF resuscitation
Treat hypoglycemia
Treat hyperkalemia (don’t use insulin/glucose method though - likely worsen hypoglycemia)
Most common cause of amenorrhea in adolescents
Pregnancy
OCP use
Pituitary infarction
Uterine synechiae in postpartum adolescents
Outflow obstruction (imperforate hymen, vaginal or uterine agenesis)
Hypoestrogenic state (anorexia, athlete)
DDx of dysfunctional uterine bleeding
Immaturity of the hypothalamic-pituitary axis PCOS Prolactinomas Thyroid dysfunction Von Willebrand disease Diabetes Adrenal hyperplasia Adrenal tumors Other chronic illnesses
2 acute complications of T1DM
DKA
Hypoglycemia
Signs/Sx of DKA
Dehydration Abdo pain Tachypnea N/V Listlessness Coma Fruity odor Ketonuria (emia) Hyperglycemia (uria) Measured hyponatremia Intravascular hyperkalemia (despite total body loss)
Describe the levels of DKA
DKA itself:
pH < 7.3, bicarb < 15, hyperglycemia (doesn’t matter how high)
MILD DKA
pH 7.21 - 7.3, bicarb 11 - 15
Normal LOC, normal resp status
MODERATE DKA
pH 7.11 - 7.2, bicarb 6 - 10
SEVERE DKA
pH < 7.1, bicarb < 5
Altered LOC
Risk factors for cerebral edema
High initial blood Urea
Lower partial pressure of CO2
Severe acidosis (lower bicarb and pH)
Administration of bicarb or bolus IV insulin
Inadequate increase in serum sodium concentration
Age < 3
First presentation of DKA
Signs and Sx of T2DM
Obesity Acanthosis nigricans Nonketotic hyperglycemia Glucosuria Weight loss Polyruia Polydipsia Rarely DKA
What is the physiological difference between T1DM and T2DM?
T1DM - insulin deficiency
T2DM - insulin resistance - overproduction of insulin - leads to relative insulin deficiency
What acute complications can T2DM experience
Hypoglycemia
DKA - less common than in T1DM
Hyperglycemic hyperosmolar state
Differentiate between DI (Diabetes insipidus) and SIADH (syndrome of inappropriate antidiuretic hormone)
Both disorders of water homeostasis
DI Free water is not reabsorbed Dilute urine in an otherwise dehydrated child Polydipsia Polyuria Fever Irritability Poor feeding Poor weight gain Constipation Hypernatremia
SIADH Unable to excrete free water Rapidly progressive hyponatremia Confusion Weakness Seizures
Tests to do - serum electrolytes, serums osmoles, urine osmoles
Definition of metabolic syndrome in kids
At least 3 of the following: Obesity Dyslipidemia Hypertension Impaired glucose tolerance
Most common symptoms of pheochromocytoma?
Headache Palpitations Excessive sweating Tremor Fatigue Chest or abdo pain Flushing
