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Y5 Paediatrics > Endocrinology > Flashcards

Endocrinology Flashcards

1
Q

What antibodies occur in T1DM?

A

anti-GAD
anti-islet cell
anti-insulin

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2
Q

What are symptoms of T1DM in a child

A

polyuria
polydipsia
Weight loss
Nocturnal enuresis

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3
Q

What is the late presentation of T1DM?

A 
DKA 
- smell of acetone on breath 
GI sx: 
- vomiting 
- dehydration 
- abdo pain 
Other: 
- Kussmaul breathing 
- Hypovolaemic shock 
- Drowsiness 
- Coma
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4
Q

What skin features indicate T1DM

A

Acanthosis nigricans

Skin tags

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5
Q

How is T1DM diagnosed?

A

Urine dip: glycosuria, ketonuria
Random blood glucose >11.1mmol/L
Fasting glucose: >7mmol/L
High HbA1c: >48

OGTT rarely required

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6
Q

Why does DKA occur?

A

Insufficient insulin means:

  • HIGH blood glucose
  • high ketone production
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7
Q

How does insulin affect ketones in a normal person

A

If person eats meal > blood glucose high > insulin immediately produced > insulin SWITCHES OFF KETONE PRODUCTION as unnecessary

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8
Q

What are the effects of high blood glucose and ketones in a child?

A

Glucose: osmotically active > polyuria, polydipsia

Ketones: acidotic environment > enzyme dysfunction> coma, death

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9
Q

What is the aim of DKA treatment

A

Rehydrate FIRST

Switch off ketone production AFTER

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10
Q

how do you calculate fluid deficit in a child?

A

total deficit volume = % deficit x weight x 10

% deficit is 5% if pH >7.2
7% if pH = 7.15
10% if pH <7.1

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11
Q

How long should you replace fluid deficit over in DKA, and why?

A

Over 48h

To avoid cerebral oedema

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12
Q

How do you manage DKA in a child?

A

FLUID BOLUS: 10ml/kg NaCl (if in shock, double)
Start insulin infusion after 1h
Once blood glucose <14 mmol/L, switch to 4% dextrose to avoid hypoglycaemia

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13
Q

why is. hypoglycaemia common in neonates?

A

Due to high energy requirements

Poor glucose. reserves

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14
Q

What is hypoglycaemia in neonates

A

Plasma glucose <2.6mmol/l

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15
Q

What are clinical features of hypoglycaemia

A

swearting
pallor
CNS signs of irritability (headache, seizure, coma)

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16
Q

What are complications of hypoglycaemia

A

Epilepsy
Severe learning difficulty
Microcephaly

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17
Q

WHat are causes of hypoglycaemia beyond neonatal period

A

Insulin excess:

  • exogenous insulin
  • Drug induced (sulphonylurea)
  • Insulinoma (beta cell tumour)
  • AI
  • Beckwith-Wiedemann

Without insulin excess:

  • Liver disease
  • -Ketotic hypoglycaemia of childhood (following period of starvation, due to poor glucose reserves)
  • Error of metabolism
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18
Q

What is management of hypoglycaemia if child is conscious

A

fast acting glucose 40% gel e.g. Glucogel

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19
Q

What is management of hypoglycaemia if child is unconscious

A

IM glucagon

IV glucose infusion (5ml/kg of 10ml bolus)

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20
Q

What are causes of congenittal hypothyroidism?

A

maldescent of thyroid
Iodine deficiency
TSH deficiency
dyshormonogenesis (error of thyroid hormone synthesis)

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21
Q

what is the most common cause of congenital adrenal hyperplasia

A

21 hydroxylase deficiency

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22
Q

what is the normal function of 21 hydroxylase in the adrenal?

A

converts progesterone to aldosterone

converts 17-hydroxyprogesterone to cortisol

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23
Q

what occurs to hormones in CAH

A

Lack of Aldosterone and COrtisol

EXCESS of androgens !!

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24
Q

what is the presentation of acute CAH

A

virilisation of external genitalia in female

  • clitoral hypertrophy
  • fusion of labia

excess virilisation in males:

  • enlarged penis
  • pigmented scrotum

SALT LOSING ADRENAL CRISIS:

  • vomiting
  • hypotonia
  • circulatory collapse
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25
Q

what is the presentation of a partial CAH

A

tall stature, muscular build, adult bodu opdour, pubic hair, acne
precocious puberty

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26
Q

What investigation should you get if suspecting CAH

A

17alpha-hydroxyprogesterone: ELEVATED MASSIVELY

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27
Q

what biochem abnormalities occur in salt losers:

A

low sodium
high potassium
metabolic acidosis
hypoglycaemia

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28
Q

How do you manage an adrenal crisis in CAH

A

IV saline
IV dextrose
IV hydrocortisone 200mg

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29
Q

What do you do for females with CAH specifically

A

corrective surgery for external genitalia

definitive surgery usually delayed until puberty

30
Q

what is long term management for CAH

A
  • Lifelong glucocorticoid (hydrocortisone)
  • mineralocorticoid (fludrocortisone) if salt loss
  • Monitor growth, skeletal maturity, plasma androgens, 17alpha hydroxyprogesterone
  • Additional hormone replacement at times of illness
31
Q

when should you start thyroxine tx in congenital hypothyroid

A

within 2-3 weeks of age

to reduce risk of impaired neurodevelopment

32
Q

what is treatment of congenital hypothyroid

A

Thyroxine replacement

LIfelong

33
Q

How can you measure fluid deficit in child with DKA

A

if pH>7.1: MODERATE DKA
so fluid deficit = 5%

if pH <7.1: SEVERE DKA
so fluid deficit =10%

34
Q

what is the formula to calculate fluid deficit in children

A

% deficit x 10 x weight (kg)

35
Q

How do you treat DKA if child is alert, not nauseated or vomiting, not clincially dehydrated

A

oral fluids

SC insulin

36
Q

when do you treat DKA with IV fluids and IV insulin

A

in children who are not alert
nauseated / voming
dehydrated

37
Q

what is IV fluid bolus in DKA

A

if shocked: 20ml/kg of 0.9%NaCL

if not shocked: 10ml/kg of 0.9%NaCl

38
Q

How do you calculate total fluid requirement after bolus

A

maintainance + deficit

39
Q

what is fluid maintainance in DKA

A

<10kg: 2ml/kg/h
10-40kg: 1ml/kg/h
40+kg: 40ml/h

40
Q

what fluid do you give for DKA

A

0.9% NaCl WITHOUT dextrose until plasma glucose <14mmol/L

THEN change to 0.9% NaCl + 5%dextrose after plasma glucose is BELOW 14mmol/L

41
Q

when do you start K+ replacement in DKA

A

as soon as urine is passed

42
Q

When do you start insulin infusion in DKA

A

1-2h after starting IV fluid therapu

43
Q

what is the IV insulin infusion dose you should give

A

0.05-0.1 U/kg/h

44
Q

what is K+ replacement in DKA

A

40mmol/L KCl in solution you are giving

45
Q

what order should you think of giving things in DKA ?

A

FLUIDS > INSULIN > POTASSIUM

46
Q

when can you change from IV insulin to subcut insulin

A

when ketosis is resolving, child is alert, child can take oral fluids wtihout nausea/vomiting

47
Q

when can you STOP IV insulin

A

Min 30 mins after starting SC insulin

Min 60 mins after staarting insulin pump

48
Q

what should you be monitoring during DKA therapy

A

Capillary blood glucose
Vital signs
Fluid balance (input and output chart)
Level of consciousness (using modified GCS)

EVERY HOUR

49
Q

What continuous monitoring do you need to get in DKA

A

CONTINUOUS ECG if IV THERAPY FOR DKA

becuase they may develop hypokalaemia

50
Q

what is the biggest neuro risk in DKA

A

cerebral oedema

51
Q

what are mild signs and symptoms of cerebral oedem

A

headache
agitation, irritability
unexpected fall in HR
increased BP

52
Q

how do you treat cerebral oedema

A

Mannitol OR hypertonic saline

53
Q

what are severe signs of cerebral oedema

A

deteriorating consciousness
abnormalities in breathing
oculopmotos palsy
pupillar abnormality

54
Q

how do you manage hypokalaemia in DKA

A

consider stopping insuilin

discuss management with paeds critical care specialist

55
Q

how do you treat hypoglycaemia in hospital

A

IV 10% glucose bolus (max 5ml/kg) followed by 10% glucose infusion

56
Q

how do you treat hypoglycaemiaa in community

A

IM glucagon (500mcg <8years old, 1mg >8)

57
Q

how does glucose cause cerebral oedema

A

HIGH GLUCOSE
changes osmolar gradient
causes water shift extracellularly

58
Q

how do you prevent cerebral oedema when treating DKA

A

rehydrate gradually, over 48h

give less fluids than you would normally

59
Q

How do you treat HYPERTHYROIDISM

A

Carbimazole / propilthiouracil (thionamides)

60
Q

what are thionoamides associed with

A

risk of NEUTROPOENIA

61
Q

what is management for T1DM

A

Insulin BASAL BOLUS regimen

62
Q

Explain insulin basal bolus regimen

A

Long acting insulin (once/twice daily, typically in the morning)

Short acting insulin before meals

63
Q

Give 2 examples of long acting insulin

A

They both start with L!

  • Lantus
  • Levemir
64
Q

Give 2 examples of short acting insulin

A

Actrapid

Novarapid

65
Q

How is insulin in basal bolus regimen administered

A

Subcut

66
Q

How is insulin administered if the patient is in hospital pre-surgery

A

Variable rate aka sliding scale

IV

67
Q

When is fixed rate IV insulin appropriate

A

in DKA

68
Q

What is the difference between metformin and sulpholyurrea in terms of their ability to cause hypos, and how does that relate to their mechanism of action

A

Metformin increases sensitivity to insulin, therefore cannot cause hypo

Sulphonylurea increases insulin quantity, so can cause hypo

69
Q

what are the three therapy choices for treating GRAVES\

A
  1. Carbimazole /PTU
  2. Radioiodine
  3. Surgery (thyroidectomy)
70
Q

What is a contraindication for radioiodine

A

avoid in eye disease as it may cause worsening

71
Q

what is risk of carbimazole

A

small risk of neutropoenia

72
Q

what is risk of surgery in Graves

A

risk of damage to recurrent laryngeal nerve

Y5 Paediatrics (30 decks)

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