Endocrine Emergency

Question 1

Non ketotic hypoglycemia

Answer 1

Too much insulin eg tumor or accident in type 1 dm
Treatment of hypo
10-15gm of rapid CHO ( 4 JB) or cordial followed by slow CHO

Severe hypo IV dextrose 2mg /kg 10% dextrose till BSL >4 and then review the cause

Question 2

Diabetic ketoacidosis

Answer 2

BSL>11.1 ph<7.3  HCO <15
Mild DKA pH<7.3 and HCO<15
Mod DKA pH <7.2. HCO <10
Severe pH <7.1. HCO <5
If severe DKA there is depletion of water and electrolytes that leads to dehydration low Na+ low K and low Cl

Question 3

If severe DKA shock

Answer 3

IV NS bolus 10-20mls /kg as a bolus
Oxygen
Insulin infusion 0.05 to 0.1 U /Kg /hr aide to
Rehydrate the sicker the child the slower the rehydration 48-72 hours 0.9NS unless hyper Na+ ( >150) great care very slow
AVOID sodium bicarbonate unless life threatening cardiac conditions
Monitor sodium/potassium and cl regularly and ABG and fluid balance
Neuro and ABG. Cerebral oedema

Question 4

Cerebral oedema

Answer 4

Important complication of DKA

Sicker the child the more likely to happen 
Treatment with mannitol 0.5-1gm /kg IV 
Reduce iv fluids 
28% die
13% neuro impairment 
60% good

Question 5

Adrenal gland

Answer 5

Produced
Aldosterone Na wasting and dehydration local management of the renin angiotensin pathway axis
Cortisol hypo glycemic and shock managed via the hypoT/pituitary access
Adrenal androgen def can have ambiguous genitalia

Question 6

Adrenal deficiency

Answer 6

Can be low sodium and dehydration and hypoglycemia  and SHock
Treatment 
If low BSL 10% glucose 2mls/kg
IV FLUIDS NS and 5% dextrose 
IV hydrocortisone 100mg/m2
Monitor K+ 
Go home on hydrocortisone or fludrocortisone 
Salt replacement 
Medical alert braclet
Written info pt letter doctor letter 
Contact details

Question 7

Sick day management of adrenal insufficiency vomiting fever sick

Answer 7

Increase the usual dose to 3x /day if mod sick and can tolerate oral
If worsening 4x per day
If unable to tolerate oral IMI and go to hospital 60-100mg/m2 per dose

Question 8

Fluid and electrolyte problems 3 groups

Answer 8

DI/SIADH/ cerebral salt wasting

Question 9

Diabetes Insipidus

Answer 9

3 types
Central. Tumor or surgery or congenital after a HI or surgery
Nephrotic defect in the kidney does not respond to ADH
Behavioral primary polydipsia

Raised Na and excessive dilute sodium
Urine volume >4mls/kg/hrfor>2hours
Low urinary sodium
So the child presents low BP and dehydration and reduced skin tugor

Treatment is
1 fluid replacement
2 strict fluid balance neutral fluid balance
3 DESMOPRESSIN GIVE ORALLY NASAL not reliable
200-400ugm/kg /day 2-4x per day

Question 10

Cerebral salt wasting

Caused by cerebral injury eg tumors hydrocephalus closed HI SAH, meningitis TB/CP

Answer 10

Waste salt so there is HIGH sodium in the urine 
Low Na+ in the blood and HypoVol
polyruia / 
Treatment is 
IV fluids 
Na replacement 
MINERALOCORTICORD fludrocortisone 
Monitor Na K+ cL closely every 6hours urine /plasma 
Daily weight
BP/ PR and capillary refill

Question 11

SIADH

Answer 11

Low sodium plasma and high urinary sodium low urinary osmolality
Decreased urine output
Pt presents with low urine outflow and FLUID OVERLOAD
Raised BP and bradycardia

Treatment is FLUID RESTRICTION 1/2 -2/3 OF maintence

Question 12

DSD Ambiguous genitalia

Answer 12

Don’t guess call the pt a baby
Exclude CAH most common cause in babies
Do # studies
USS of genitals if absence genitalia /testicles look for a gonad if yes = Male

Question 13

Thyroid storm. RARE

Answer 13

Maternal hyperthyroid /GRAVES

Will cause neonatal thyrotoxicosis treat with b blockers /carbamisol

Question 14

Hypoglycemic and got ketones

Answer 14

Problem is in the adrenal/ raised glycogen 
Problem with raised growth hormone 
And ? Raised cortisol 
Investigations 
Do BSL u/e and insulin and LFTS 
FFA and ketones 
Cortisol / human growth normal 
Urine ketones and metabolic screen / aa/ g