Endocrinology Flashcards
Which endocrine disorder is most strongly associated with trisomy 21?
Hypothyroidism
What glucose bolus is given to children who are hypoglycaemic?
10% glucose solution
2mL/kg
What ketones may be present in DKA?
- Acetone
- Acetoacetate
- Beta-hydroxybutyrate
Which ketone is most sensitive for detecting early DKA?
Betahydroxybutyrate
Throughout management of DKA, betahydroxybutyrate levels decrease while acetacetate levels increase. What does this suggest?
Normal
Betahydroxybutyrate is converted to acetoacetate
What is the biochemical criteria for DKA?
Hyperglycaemia, defined by a BGL > 11mmol/L
Venous pH <7.3 or bicarbonate < 15mmol/L
Presence of blood or urinary ketones
What happens to K+ during DKA?
Moves extracellularly → lost in urine
Moves intracellularly with insulin administration
What is the most significant cause of mortality in children with DKA?
Cerebral oedema
Which biochemical marker is elevated in rickets?
ALP
Which antibodies are measured to support a diagnosis of T1DM?
Anti-glutamic acid decarboxylase (anti-GAD)
What is the target BSL range for children with diabetes?
4-8 mmol/L
What is the target HbA1c for children with diabetes?
7%
What is the approximate daily insulin requirement for a T1DM child?
1 unit/kg/day
Why might patients with DKA have abdominal distension/succussion splash/acute gastric dilatation?
Gastroparesis from metabolic acidosis
What can cause SIADH?
Any CNS disorder e.g., stroke, haemorrhage, trauma, meningitis
Pulmonary disease e.g., pneumonia, asthma, bronchiolitis, pneumothorax
Tumour e.g., small cell carcinoma (lung)
Medications e.g., carbamazepine, chlorpropamine, SSRIs
How is fluid balance in children with SIADH managed?
2/3 total daily requirement
What is the definition of a base excess?
The amount of acid required to restore a litre of blood it its normal pH
Increases in alkalosis and decreases in acidosis
What are the macrovascular complications of diabetes?
- Peripheral vascular disease (atherosclerosis)
- Ischaemic heart disease
- Stroke
Which GLUT receptor is present in the brain?
GLUT 1
Which GLUT receptor is present in the pancreas and liver?
GLUT 2
Which antibodies are most strongly associated with Graves’ disease?
TSH receptor antibodies (TRAb)
Have a stimulating effect
Which antibodies are most strongly associated with Hashimoto’s thyroiditis?
Thyroid peroxidase antibodies (TPOAb)
Thyroglobulin antibodies (TgAb)
- → Hashimoto’s → release of thyroglobulin → antibody formation*
- Not implicated in disease process per se*
What are the causes of short stature?
A - alone (neglect)
B - bone dysplasia (rickets, scoliosis, mucopolysaccharidoses)
C - chromosomal (Down, Turner)
D - delayed growth (constitutional)
E - endocrine (low GH, Cushing, hypothyroid)
F - familial
G - GI malabsorption (coeliac, Crohn’s)
Why is corrected sodium used in DKA management?
There is a dilutional effect of hyperglycaemia and hyperlipidaemia
How is corrected sodium calculated in DKA?
Sodium + glucose/3
What fluid bolus is given in DKA?
If red zone (shocked) - 20mL/kg
If yellow zone - 10mL/kg
If potassium replacement is indicated in DKA therapy, what dose is given?
40 mmol/L in 0.9% NaCl
During DKA treatment, how do the fluids change once BGL is 14 mmol/L or less?
Change to 0.45% NaCl + 5% glucose
How do you dose insulin therapy in DKA?
Add 1 unit/kg body weight into 50mL of 0.9% NaCl
Run at 5mL/kg
Equates to 0.1 unit/kg/hour
