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Phase 3a - Paediatrics > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What are the components of the classic triad of diabetes? What also may be observed?

A

Hyperglycemic triad - polyuria, polydipsia, weight loss (dehydration)
- Secondary enuresis (bedwetting) and recurrent infections

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2
Q

What diagnostic tests should be carried out for diabetes mellitus?

A
  • Baseline bloods
  • HbA1c
  • TFT - TPO to check for autoimmune thyroid disease
  • Anti-TTG - associated with coeliac disease
  • Consider insulin antibodies
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3
Q

Describe the basal-bolus regime:

A

Basal = long-acting insulin the evening
Bolus = short acting insulin prior to meals

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4
Q

What are some pros of the insulin pump (tethered or patched) as a management for DM?

A

Pros:
- Better sugar control
- Flexible eating
- Less injections

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5
Q

What are some cons of the insulin pump as a management for DM?

A

Cons:
- Challenges in using pump
- Attached at all times
- Blockage + infection

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6
Q

Complications of untreated/uncontrolled DM?

A
  • Hypoglycemia
  • Nocturnal hypoglycemia
  • Hyperglycemia
  • Macrovascular, microvascular complications
  • Infection
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7
Q

What are symptoms of hypoglycemia?

A

Too much insulin: hunger, tremor, sweat, irritable (mood change), dizzy, pallor
(LOC, coma, death if untreated)

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8
Q

What is the treatment for hypoglycemia?

A

Rapid acting glucose, slow acting carbs or IV dextrose, IM glucagon

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9
Q

How should nocturnal hypoglycemia be treated?

A

Sweaty overnight so raised glucose - bolus insulin regime and bedtime snack

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10
Q

Name the microvascular and macrovascular complications of DM?

A

Macrovascular: stroke, CAD, HTN, diabetic foot (peripheral ischemia)
Microvascular: peripheral neuropathy, retinopathy

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11
Q

What are potential infections of DM patients?

A

UTI, pneumonia, fungal

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12
Q

What is the target range of HbA1c?

A

Risk of developing T2DM, HbA1c: <42mmol/mol
If you are controlling T1DM, HbA1c: <48mmol/mol

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13
Q

What is the treatment for diabetic ketoacidosis (DKA)?

A

IV mannitol, IV hypertonic saline

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14
Q

Describe the pathophysiological process where diabetic ketoacidosis is caused?

A
  1. Not enough glucose nor glycogen stores
  2. Liver takes fatty acids and converts to ketones
  3. Ketone soluble so cross B-B barrier
  4. Used by brain
  5. Normally buffered in healthy individual, but unhealthy unable to buffer
  6. Hyperglycemia ketosis
  7. Metabolic ketoacidosis (:. diabetic ketoacidosis)
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15
Q

What are the risks of DKA?

A
  1. Ketoacidosis
  2. Dehydration
  3. Potassium imbalance
  4. Cerebral oedema
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16
Q

What is the treatment for DKA?

A

IV mannitol, IV hypertonic saline

17
Q

How will a patient in DKA present?

A

Polyuria, polydipsia, N/V, WL, acetone smell on breath, dehydration, hypotension, altered consciousness

18
Q

Addison’s disease?

A

Adrenal glands damaged - reduced cortisol and aldosterone

19
Q

What causes Addison’s disease?

A

Autoimmune and primary adrenal insufficiency

20
Q

What is secondary adrenal insufficiency?

A

Inadequate ACTH stimulating the adrenal glands so less cortisol released

21
Q

What causes secondary adrenal insufficiency?

A

Pituitary gland damaged due to congenital underdevelopment, surgery, infection

22
Q

What is tertiary adrenal insufficiency?

A

Not enough CRH released by hypothalamus

23
Q

What causes tertiary adrenal insufficiency?

A

Long-term steroid use suppressing the hypothalamus

24
Q

What is adrenal insufficiency?

A

Insufficient cortisol and adrenaline produced by the adrenal glands

25
Q

What are the clinical features of a baby who is adrenal insufficient?

A

Lethargic, poor feed, failure to thrive, vomiting, hypoglycemia, jaundice

26
Q

How may an older child who is adrenal insufficient present?

A
  • Anorexic, abdominal pain, muscle cramp/weakness
  • N/V, poor WG/WL
  • Developmental delay/poor academic performance
  • Addison’s: toned, tanned, tearful
27
Q

Explain the synacthen test for adrenal insufficiency

A
  1. Give synacthen (synthetic ACTH)
  2. Take blood cortisol at baseline, 30 min, 60 min.
  3. If cortisol not double baseline then Addison’s
28
Q

What is the management for adrenal insufficiency?

A
  • Hydrocortisone - replace cortisol
  • Fludrocortisone - replace aldosterone
29
Q

A patient with known adrenal insufficiency is experiencing diarrhoea and vomiting what should the management plan be?

A

IM steroid injection and consider hospital admission for IV steroid

30
Q

What is the signs of a adrenal crisis?

A

Reduced consciousness, hypotensive, hypoglycemic/hyponatremia/hyperkalemia

31
Q

What are the triggers for adrenal crisis?

A

1st episode, infection, trauma, other acute illness, abruptly stop steroids

32
Q

What is the management for an adrenal crisis?

A

IV hydrocortisone, fluids, correct hypoglycemia, careful electrolyte and fluid balance

Phase 3a - Paediatrics (11 decks)

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