Endocrinology Flashcards
What are the markers of beta cell destruction?
Islet cell Abs (ICA), Abs to glutamic acid decarboxylase (GAD), Abs to insulin (IAA)
Which gene is assoc with increased risk T1DM?
HLA-DR3/4 +ve
Dx criteria for T1DM?
Random glucose or OGTT >11.1, or fasting glucose >7
Tx regimes for T1DM?
Basal bolus, 1/2/3 injections a day, continuous insulin pump
What are blood glucose aims in T1DM?
morning fasting: 4-7, pre-meal 4-7, post meal 5-9, when driving at least 5
What is the Mx of hypoglycaemia in a conscious child at school?
1) give 10-20g fast-acting glucose, e.g. lucozade
2) recheck BM in 15mins, repeat step 1 if need to
3) give 10-20g long-acting complex carbohydrate, e.g. slice of bread
Mx of hypoglycaemia in unconscious child with IV access?
IV bolus 10% dextrose, max dose 500mg/kg
Mx of hypoglycaemia in unconscious child without IV access?
IM glucagon.
If >8y or >25kg - 1mg
If <8y or <25kg - 500mcg
Dx criteria for DKA?
Blood glucose >11.1
pH <7.3 or HCO3 <18
Plasm ketones >3, or urine ++
Definition of severe DKA?
pH <7.1 (10% dehydrated)
What maintenance fluids do you give for DKA?
- <10kg - 2ml/kg/hr
- 10-40kg - 1ml/kg/hr
>40kg - fixed 40ml/hr
How do you work out the fluid deficit (ml) needed?
Fluid deficit = % dehydration x weight x 10
What fluids do you give in DKA?
0.9% saline with 40mmol/L potassium chloride (unless bolus or in renal failure)
When do you give 5% dextrose in DKA?
When BM <14.
Mx once urine is ketone free in DKA?
If not eating - sliding scale insulin
If eating - start SC insulin 30 mins before stopping IV.
Signs of cerebral oedema in DKA?
headaches, agitation, rapid decrease HR, increase BP, sudden resp arrest
Mx cerebral oedema in DKA?
Immediate IV mannitol: 20%, 0.5-1g/kg over 10-15 mins
What classifies mild vs severe FTT?
Mild = falls across 2 centimes, severe = 3+
What is catch-down weight?
When baby’s weight drops from birth gentile. Baby finds its genetically determined growth gentile rather than the one determined by IU environment
Dx of child with deficiency of 21-hydroxylase?
Congenital adrenal hyperplasia
What is a potential complication of congenital adrenal hyperplasia?
Salt loss - leads to adrenal crisis, nom, WL, flops, circulatory collapse
What electrolyte deficiency might you see in child with CAH?
Low Na, raised K (due to lack of aldosterone production)
At what age is puberty considered precocious?
<8y in girls, <9y in boys
most common cause precocious puberty in boys?
intracranial tumours
Potential cause of boy with precocious puberty with small testes?
Adrenal cause - tumour, CAH
What age is delayed puberty?
girls - 14y, boys - 15y
Features of child with constitutional delay in puberty?
Short in childhood, delayed sexual maturation & skeletal maturity, long legs
What tests are important to do in disorders of sexual development?
Karyotype (girls - Turner’s), measure adrenal & sex hormone levels, USS internal structures, thyroid hormones
Mx of delayed puberty in boys?
Younger - oxandrolone
Older - IM testosterone
Poss Sx of congenital hypothyroidism?
Usually asymptomatic but picked up on Guthrie. If not - FTT, prolonged neonatal jaundice, constipation, large tongue, pale, cold, mottled
What might a deficiency of biopterin cofactor suggest?
PKU. Also deficiency of phenylalanine hydroxylase
Child is complaining of going to the toilet a lot and feeling weak. Bloods show raised Na and low K. Possible Dx?
Conn’s syndrome. Increased aldosterone –> increased Na reabsorption and increased K loss
What features might you expect in a child with short stature due to an endocrine abnormality?
Relatively overweight
