EXAM #2: DM & THYROID DISEASE IN PEDS Flashcards
What race shows a predominance of IDDM?
Caucasian
In what age group is NIDDM most common in?
Adults
*Note that it is becoming more common in obese children
What are the three P’s of IDDM?
- Polyuria
- Polydipsia
- Polyphagia
What glucose levels “sinch” the diagnosis of DM?
Random= 300 mg/dL or higher Fasting= 200 mg/dL or higher
What HLA antigens are associated with DM-I?
HLA-DR3 and 4
Generally, how is insulin dosed for the DM-I patient?
- 2/3 of the daily dose before breakfast
- 1/3 of the daily dose before dinner
*Typically, 2/3 of this insulin dose is long-acting, and 2/3 is short-acting
What foods are DM-I patients told to specifically avoid?
Pure sugar foods
How often should DM-I peds check their blood sugar?
Twice daily, more if ill or having difficulty maintaining glucose control
What is the goal blood glucose level for the newborn- 4 y/o?
100-200 mg/dL
What is the goal blood glucose level for the 5-12 y/o?
80-180 mg/dL
What is the goal blood glucose level for the 13+ y/o?
70-150 mg/dL
When should you perform urine ketone monitoring?
- Any time there is significant illness
- Single episode of vomiting (or more)
- Blood sugar is 240 mg/dL
What is HbA1c?
Measure of non-enzymatic glycation that occurs on the beta chain of the hemoglobin molecule upon exposure to glucose in the plasma
What HbA1c is part of the diagnostic criteria for DM?
Greater than 6.5%
What is the mnemonic to remember the symptoms of hypoglycemia?
The symptoms of hypoglycemia can remembered with the mnemonic STAB AT diabetes:
- Sweating
- Tremor
- Anxiety or agitation
- Blurry vision
- Altered mental status
- Tachycardia
*This is treated with oral sugar (OJ) first
What are the diagnostic criteria for DKA?
- Blood glucose greater than 200 mg/dL
- Venous blood gas with pH less than 7.3 OR bicarbonate less than 15 mEq/L
How is DKA treated?
1) Restore intravascular fluid volume
2) Insulin
3) Replacement of body salts (Na+, K+, and PO4)
*At a blood sugar of roughly 300, glucose is added to fluid to prevent “bottoming-out”
What is a major complication of DKA?
Cerebral edema
What can be done to avoid cerebral HTN and brainstem herniation in DKA?
1) Avoid over-zealous fluid resuscitation
2) Slowly decrease blood sugar
What happens to K+ in the setting of acidosis?
Shift of K+ extracellularly–correction will shift K+ back into the cells
What should be avoided in the correction of acidosis in DKA?
Sodium bicarbonate
What are the long-term complications of DM?
1) Retinopathy
2) Neuropathy (stocking-glove)
3) Renal damage
Describe the fetal and maternal pituitary-thyroid axes?
Independent
What do you need to remember about anti-thyroid drugs in pregnant mothers?
These drugs cross the placenta and can affect fetal thyroid homeostasis
When clinically evaluating the thyroid of a newborn, what should you do if TSH is normal?
Nothing
When clinically evaluating the thyroid of a newborn, what should you do if TSH is high?
Add T4 to determine the degree of hypothyroidism
When clinically evaluating the thyroid of a newborn, what should you do if TSH is low?
Add T4 and T3 to determine degree of hyperthyroidism
What causes most cases of hypothyroid in peds? What clinical sign are you likely to see in this presentation?
Hashimoto’s Thyroiditis w/ goiter
What kind of anemia is associated with hypothyroidism?
Normocytic
A pediatric patient has an exquisitely tender thyroid and a toxic appearance, what is the most likely diagnosis?
Acute suppurative thyroiditis
How does bone maturation differ between hypothyroidism and hyperthyroidism?
Hypo= delayed w/ epiphyseal stippling
Hyper= advanced bone age
