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3A paediatrics > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What is the most common type of diabetes in children?

A

Type 1 diabetes

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2
Q

What is the normal ranges of glucose in a child?

A

Fasting = 3.5-5.6 mmol/l

Post prandial = <7.8 mmol/l

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3
Q

How do you diagnose type 1 diabetes in children?

A

Oral Glucose tolerance test or random plasma glucose

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4
Q

What are the values needed to diagnose diabetes in an OGTT?

A

Diabetes
Fasting = ≥7.0mmol/L
Random = ≥11.1mmol/l
HbA1c = > 6.5%

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5
Q

What are the main symptoms of T1 Diabetes?

A

Toilet, thirst, tired, thinner

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6
Q

What genes have been indentified to be linked with Type 1 diabetes?

A

HLADR3

HLADR4

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7
Q

What are the relative risks associated with having a family history of diabetes?

A

Mother - 2% risk
Father - 8% risk
Both parents - 30% risk

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8
Q

How does diabetes present in the late stages?

A

Ketoacidosis

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9
Q

Are ketones are normally found in the blood?

A

<0.6 in blood

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10
Q

Why would you do a blood gas in a newly diagnosed type 1?

A 
IE. 
pH 7.06
pCO2 2.8
BE – 15
HC03 13

Shows Metabolic Acidosis
(CO2 low - HCO3 High)

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11
Q

What are the steps to manage DKA?

A 
Fluid!!!
Insulin
Monitor glucose hourly
Monitor electrolytes, especially K+ and ketones - 2 hourly
Very strict fluid balance - hourly I/O
Hourly neuro obs
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12
Q

What are the dangerous complications in DKA after treatment ?

A 
cerebral oedema
shock
hypokalaemia
aspiration
thrombus
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13
Q

What are the fluid deficit assumptions for a child in varying degrees of DKA?

A

Assume a 5% fuid defcit in mild DKA (indicated by a
blood pH 7.2-7.29 &/or bicarbonate <15)

Assume a 7% fuid defcit in moderate DKA (indicated by a
blood pH of 7.1- 7.19 &/or bicarbonate <10)

Assume a 10% fuid defcit in severe DKA (indicated by a
blood pH <7.1 &/or bicarbonate <5

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14
Q

What is the Fluid management for DKA?

A

Do not subtract boluses given for shock

Give normal maintenance fuids + correct the
defcit

Correct for dehydration over 48 hours

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15
Q

Calculate the fluid needed for a 26kg male child after boluses of fluid are given?

A

Replacement:
26 kg = 26L x 10% = 2.6L
dehydrated (2600 ml)
2600 / 48 hours = 54 ml/hr

Maintenance
1620ml (Using 100,50,20 rule)
68 ml/hr

Total
122 ml/hr

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16
Q

What are the symptoms of a Hypo?

A 
Irritable
• Hungry
• Nauseous
• Shakey
• Pallor
• Anxious
• Sweaty
• Palpitations
• Pallor
17
Q

What is the management for a mild Hypo?

A

Check blood glucose to confirm
3-5 glucose tablets
100-200ml fizzy drink (not diet) or juice
60-100mls lucozade
Wait 10 minutes - if no improvement repeat
FU with longer acting carb (bread/biscuit)
Check BG in 15 minutes

18
Q

What is the management for a moderate Hypo?

A

As for mild if possible
If too unwell - 0.5-1 tube glucogel
Wait 10 minutes - if no improvement repeat
FU with longer acting carb (bread/biscuit)
Check BG in 15 minutes

19
Q

What is the management for a severe Hypo?

A 
Do not attempt to give anything by mouth
Glucagon - s/c or i/m injection
if < 5 years = 0.5mg
if > 5 years = 1mg
Wait 10 minutes
When conscious give sugary
20
Q

What are the main goals fo Type 1 management?

A 
Normal growth and development
As normal a childhood as possible
Transition with optimal HbA1c to help prevent
complications
Avoidance of XS or severe hypos
21
Q

what is the normal carbohydrate to insulin ration?

A 
1 unit for every 15
grams. (Correction factor
1 unit to bring blood
glucose down by 8
(aiming for a BG of 6))
22
Q

If Current blood
glucose: 14.2
About to eat 50g of fusilli (With 17 grams carbs)

How much insulin will be needed?

A 
17g = 1 units
Correction = 1 unit

Want to bring it down by 8 aswell
so +1 unit

Total = 2 units

23
Q

What do we monitor in patients with T1D

A

HbA1c - 3-month profile
BG log book/download
AI screen

CHANCE TO EDUCATE
• Alcohol
• Contraception
• Knowledge - exercise,
sick day rules
24
Q

What should you always examine in a T1D?

A 
Eyes
• Urine
• Feet
• Blood pressure
• Injection sites
25
Q

What is the FIRST STEP in treating a DKA

A

DKA - fluid before insulin!!

26
Q

What HBA1C should we be aiming for in patients with T1D

A

<48 mmol

27
Q

When do children transition to their own autonomous care?

A 
Should start from the age of 12
“Developmentally appropriate stage”
Joint clinic
Sex, drugs, alcohol, contraception, driving,
heading to uni

3A paediatrics (4 decks)

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