Exam 2: Endocrine Disorders Flashcards
Endocrine system functions to control and regulate metabolism including
- Energy production
- Growth
- Fluid and electrolyte balance
- Stress response
- Sexual development
Pediatric Differences in the Endocrine System
- Less developed at birth
- Hormonal control is lacking until about 12-18 months: more difficulty regulating fluid and electrolytes, amino acids and glucose
Diabetes Insipidus
- Inability to concentrate urine
- Deficiency of vasopressin (ADH)
- Not common
- Inherited or acquired
What are clinical manifestations of diabetes insipidus?
- Increased urination
- Excessive thirst
- Nocturia
- Dehydration
How is Diabetes Insipidus evaluated?
- Low urine specific gravity (absence of hyperglycemia)
- Urine restriction
Diabetes Insipidus: To confirm diagnosis
-Water deprivation test: continues to have large amounts of dilute urine; serum sodium level increases
Diabetes Insipidus Management
- Maintain fluid balance: allow free access to water and toilet facilities
- Monitor urine specific gravity
- Administer DDAVP
- Monitor for signs of dehydration
Syndrome of Inappropriate Antidiuretic Hormone (SIADH)
- Excessive production or release of ADH or vasopressin
- Rare in childhood
- Usually related to underlying cause
- Usually transient and resolves when underlying condition is corrected
What are clinical manifestations of SIADH?
- Hyponatremia
- Decreased urine output
- Fluid retention
- Weight gain
- Increased urine specific gravity
- Increased urine osmolarity
SIADH Evaluation
- Consider in children with CNS involvement: infections, head trauma
- Decreased urine output with adequate intake
SIADH: Labs
- Hyponatremia
- Hypochloremia
- Low serum osmolarity
- Urine specific gravity >1.030
Management of SIADH
- Correct underlying cause
- Monitor neurologic status q2-4 hours
- Monitor for seizures
- Monitor F&E balance
Pathophysiology of SIADH
- Excessive ADH -> kidney reabsorbing too much water -> decreased output of concentrated urine
- Excess water -> dilution of sodium levels
SIADH: If Na falls below <125 mEq/L, what symptoms would you expect to see?
- Nausea
- Anorexia
- Weakness
- Confusion
- Irritability
- Seizures
Take a look at comparison of DI and SIADH on slide 8 of PowerPoint
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Sexual Maturation: Tanner Staging
See pag 450-453
Sexual Maturation: Female
Typically begins between age 8-13:
- Breast buds show sign of ovarian function
- Pubic hair
- Adult body odor
- Contour.
When does female menarche usually begin?
Between ages 10-15
When does ovulation usually occur?
6-14 months after menarche
When is a female growth height reached?
2-2 1/2 years after menarche
Sexual Maturation: Male
- Typically begins between 9-14:
- Testicular enlargement
- Penile enlargement
- Pubic hair - Reproductive maturity usually later than girls
- Gynecomastia
- Deepening of voice
When does growth spurt occur in males?
10-16 years of age
How long does a male continue to grow for?
Continues to grow until about age 20
Precocious Puberty
- Premature appearance of secondary sexual characteristics, accelerated growth rate and advanced bone maturation.
- Aka early onset of puberty
Precocious Puberty usually occurs when?
- Before age 8 in girls
- Before age 9 in boys
What is a major consequence of precocious puberty?
Rapid bone growth which causes early growth plate fusion and shorter stature.
What are clinical manifestations of precocious puberty in girls?
- Breast Development
- Pubic and axillary hair
- Enlargement of vagina, uterus and ovaries
- Growth spurt
- Acne
- Adult body odor
- Onset of menstrual periods
- Moodiness
What are clinical manifestations of precocious puberty in boys?
- Testicular enlargement
- Penile enlargement
- Pubic hair
- Facial hair
- Acne
- Adult body odor
- Deepening of voice
- Moodiness
Precocious Puberty: Evaluation
- History: onset of secondary sexual characteristics
- Physical exam
- Gonadotropin-releasing Hormone Stimulation Test: differentiates between central and peripheral cause
- Radiographs of wrists: determines bone age and maturation; predicts adult height
- Abdominal ultrasound: diagnoses adrenal and ovarian tumors or cysts
Precocious Puberty: Treatment is aimed to
- Correct underlying cause
- Stop or reverse the development of secondary sexual characteristics
- Maximize adult height
Precocious Puberty Management
Administration of GnRH agonist or blocker (slows/reverses sexual development)
What are complications of precocious puberty?
-Growth plates fused earlier and bone age earlier -> higher risk of osteoporosis
Diabetes Mellitus
Chronic disorder of metabolism characterized by hyperglycemia and insulin resistance.
Type I Diabetes Mellitus
- Most common in childhood
- Pancreas is unable to produce and secrete an adequate amount of insulin
- No prevention or cure is available
Type I DM in Children
Prone to develop other autoimmune conditions such as Graves’ disease, Hashimoto thyroiditis and Celiac disease
What are clinical manifestations of DM?
- 3 P’s: Polyuria, polydipsia and polyphagia
- Weight loss
- Increased food intake
- Fatigue
- Blurred vision
Signs of DKA
- N/V
- Abdominal pain
- Acetone (fruity) odor to breath
- Dehydration
- Increased lethargy
- Kussmaul respirations
- Coma
Evaluation of DM: Labs
- Fasting blood glucose >126
- Random serum glucose >200
- Oral glucose tolerance test >200
- Hemoglobin A1C of 6.5% or > (< 7% is good)
Diabetes Mellitus Management: Insulin Honeymoon Phase
- Occurs after initiation of insulin therapy
- Characterized by hypoglycemia and a decreased need for insulin
- May last from a few weeks to a year
Insulin Requirements are based on
- Age
- Body weight
- Pubertal status
Honeymoon Phase: Nursing responsibility
Prepare the child and family for the possibility of honeymoon phase, both to:
- Avoid misconception that the diabetes is going away
- And to provide instruction on recognition and treatment of hypoglycemia
Signs and Symptoms of Hypoglycemia
- Sweating
- Trembling
- Dizziness
- Mood changes
- Hunger
- Headaches
- Blurred vision
- Extreme tiredness and paleness
Signs and symptoms of hyperglycemia
- Dry mouth
- Frequent urge to urinate
- Extreme thirst
- Drowsiness
- Stomach pain
- Frequent bed wetting
Diabetes Mellitus Management: Nutrition
Build a diet plan:
- Consistent intake that is easy to understand and tailored to food preferences
- Change as needed to meet child’s dietary needs
Diabetes Mellitus Management: Physical Activity
- Encourage to participate in age appropriate activities
- Teach how to prevent hypoglycemia
- Maintain proper hydration
- Avoid exercise when insulin is peaking
- Add carbohydrates as appropriate for exercise
- Monitor blood glucose before exercise
Diabetes Mellitus Management: Developmental Issues
- Know the developmental characteristics of each age group
- Allow for child to manage task as appropriate for age.
- Let the child help with diet
Insulin Management
- Store insulin in cool, dry place. Don’t freeze or expose to excessive heat.
- Do not shake; roll vial back and forth
- Check expiration date before using
- Once opened, date the vial
- When mixing: Inject right amount of air into both vials, withdraw clear (short) FIRST then cloudy (intermediate)
DM Management: Blood Glucose Monitoring
- Record blood glucose results in diary
- A 3-4 day alteration in glucose levels requires an adjustment of insulin doses
What are complications of DM?
- Hypoglycemia
- Hyperglycemia
- DKA
DM Management: Sick Days
- Illness, infection and stress = increased need for insulin.
- Do not withhold insulin during these times
- May lead to hyperglycemia and ketoacidosis
DM: Sick Day Managment
- ALWAYS give insulin even if they don’t want to eat.
- Test blood glucose q4H or more if hypo or hyperglycemic
- Test urine ketones w/ each voiding
- Encourage intake of caloric free liquids (aids in clearing ketones from blood)
- Follow child’s usual meal plan: replace the usual grams of carbs with simple carbs used
- Encourage rest: exercise = ketones
- Notify if symptoms of DKA
Types of Insulin
Not sure if going to be tested on
DKA
Consequence of a severe insulin deficit leading to hyperglycemia, ketone bodies in the blood and metabolic acidosis
Most common causes of DKA in children
- Insulin resistance
- Stress
- Infection
Most common causes of DKA in adolescents
-Missed insulin injections
What are clinical manifestations of DKA?
- N/V
- Dehydration symptoms
- Kussmaul respirations
- Fruity breath
- Abdominal or chest pain
- Decreased LOC
Management of DKA
- Admission to PICU
- Restore circulating volume
- Monitor:
1. Glucose (administer IV insulin)
2. I&O
3. V/S
4. Neuro checks
5. IV fluid replacements (0.9% or 0.45% NS to correct dehydration)
6. F&E status (K+ levels change when child receives insulin; if it decreases -> K+ replacement but make sure they are voiding adequately to prevent hyperkalemia)
DKA: Labs
- Blood glucose >300 mg/dL
- Urine and serum ketones: (+)
