Endocrinology Flashcards
What are the features of type 1 diabetes
Most children present in DKA or hyperglycaemia
Polyuria, polydipsia, weight loss
Can have secondary enuresis (bedwetting) and recurrent infections
1-6 weeks before a DKA
Long term management with
Subcut insulin
Dietary carb monitoring
Monitoring blood sugar- waking, each meal and before bed
What bloods need to be done in a new diagnosis of type 1 diabetes
FBC, U&E, formal lab glucose
Blood cultures if suspected infection (with fever)
HbA1c for blood sugar over 3 months
Thyroid function tests and thyroid peroxidase antibodies (TPO)
TTG for coeliac
Insulin antibodies, anti-GAD antibodies and islet cell antibodies
What insulin regime is used in Type 1 diabetes
Basal Bolus regime
Once daily long acting insulin (Lantus) in the evening
Short acting insulin 30 mins before meals (Actrapid)-
Also injected based on no of Carbs consumed in a snack
(Move location to stop lipodystrophy)
Can have an insulin pump instead to continuously infuse insulin
Pump replaced every 2-3 days - child needs to be over 12 and have issues controlling HbA1c
Tethered pump-replaceable infusion sets and insulin- attached to belt/ waist
Patch pumps on skin- when run out of insulin dispose of entire pump
How are hyper and hypoglycaemia managed in paeds
Combination of rapid acting glucose (lucozade etc) and slower acting carbs (biscuits)
Severe hypo- IV dextrose 10% 2mg/kg bolus then 5mg/kg.hour or IM glucagon
Nocturnal hypoglycaemia- child may be sweaty over night with morning blood glucose levels raised - needs continuous glucose monitoring to diagnose and alter insulin and give snacks at bed time
Hyperglycaemia- increased insulin dose unless they meet DKA criteria and need admitted
What is the pathophysiology of DKA
Ketosis- build up of ketone acids as body cannot process glucose so thinks it’s starving
Excess glucose in urine draws water out too - severe dehydration
Insulin normally drives potassium into cells- serum potassium is high but intracellular (total body)potassium is low
How is cerebral oedema associated with DKA in paeds
Dehydration and high blood sugar concentration causes water to move from intracellular space to extracellular space
Brain cells shrink and become dehydrated
Rapid correction of dehydration and hyperglycaemia will cause shift in water into brain cells causing swelling and cerebral oedema
Monitor GCS hourly to look for signs- headaches, bradycardia, altered behaviour, consciousness changes
How is cerebral oedema managed
Slow IV fluids
IV mannitol
IV hypertonic saline
How is DKA managed in children
- Correct dehydration over 48 hrs - no faster- cerebral oedema risk
- Fixed rate insulin infusion
- IV dextrose once glucose goes below 14
- Add potassium to Fluids and monitor closely
- Monitor for cerebral oedema
Don’t give fluid blouses (risk of cerebral oedema)
Treat underlying triggers- eg sepsis
What are the features of Adrenal insufficiency in babies and children
Baby:
Lethargy, vomiting, poor feeding, hypoglycaemia, jaundice, failure to thrive
Older Children:
Nausea and vomiting, poor weight gain/ loss, reduced appetite, abdo pain, muscle weakness/cramps, developmental delay, bronze hyperpigmentation
What findings would be present in primary and secondary adrenal insufficiency
Addison’s (Primary)
-Low cortisol
-High ACTH (trying to stimulate)
-Low aldosterone (mineralocorticoid)
-High renin (trying to stimulate)
Secondary
-Low cortisol
-Low ACTH
-Normal aldosterone
-Normal Renin
What are the sick day rules for steroid users
Temp over 38- vomiting or diarrhoea- dose of steroid increased and given more regularly
Blood sugar monitored and eat regular carbs
Diarrhoea and vomiting- IM steroids at home and admission for IV steroids
How does Addisonian crisis present/ How is it managed
Reduced conciousness
Hypotension
Hypoglycaemia, hyponatraemia, hyperkalaemia
Management
Intensive monitoring
Parenteral steroids -IV hydrocortisone
IV fluid resus
Correct hypoglycaemia
Monitor electrolytes
What are the features of congenital adrenal hyperplasia
Congenital deficiency of 21-hydroxylase enzyme
Underproduction of cortisol and aldosterone and over production of androgens
Autosomal recessive
Low aldosterone and cortisol with high testosterone
What are the severe signs and symptoms of congenital adrenal hyperplasia
Females with ambiguous genitalia when born- enlarged clitorus
Hyponatraemia, hyperkalemia and hypoglycaemia
Poor feeding, vomiting, dehydration and arrhythmia
What is the mild presentation of congenital adrenal hyperplasia
Female
Tall for age
Facial air
No periods
Deep voice
Early puberty
Male
Tall for age
Deep voice
Large penis
Small testicles
Early puberty
Skin hyperpigmentation**
