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8361 Exam 2 > Mod IV: Pediatric Hematologic - Renal - Endocrine - Hepatobiliary - GI - Thermoregulation - Central Nervous System > Flashcards

Mod IV: Pediatric Hematologic - Renal - Endocrine - Hepatobiliary - GI - Thermoregulation - Central Nervous System Flashcards

1
Q

Hematologic System

What’s normal Hemoglobin in a healthy newborn?

A

19g/dl

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2
Q

Hematologic System

What’s normal Hemoglobin in premature infant?

A

13-15g/dl

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3
Q

Hematologic System

What percentage of Hemoglobin in newborn and infant is fetal hemoglobin (HgbF)?

A

70-80%

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4
Q

Hematologic System

Why is Neonatal oxyhemoglobin curve shifted to the left?

A

To increase hemoglobin affinity for O2

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5
Q

Hematologic System

Neonatal oxyhemoglobin curve shifted to the left. This increases hemoglobin affinity for O2. What are advantages of this?

A

Increase ability to uptake O2 from the mother a the placental interface

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6
Q

Hematologic System

Neonatal oxyhemoglobin curve is shifted to the left. This increases hemoglobin affinity for O2. What are disadvantages of this?

A

Decreases the release of O2 to the tissues,

which makes them prone to hypoxemia

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7
Q

Hematologic System

The neonatal oxyhemoglobin curve is shifted to the left. This increases hemoglobin affinity for O2. A disadvantage of this is a decrease in the release of O2 to the tissues, which makes them prone to hypoxemia. What is this compensated by?

A

Increase in CO

Higher Hgb levels

Increase in blood volume per kg, as compared to an adult

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8
Q

Hematologic System

What is the P50 of HgbF?

A

18-20

<em>(What’s P50?)!!!!</em>

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9
Q

Hematologic System

What’s P50 of hemoglobin? What’s normal P50?

A

The P50 of hgb is the oxygen tension at which hemoglobin is 50% saturated

The normal P50 is 26.7 mm Hg

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10
Q

Hematologic System

What’s the mormal P50 for adult Hgb?

A

27 mmHg

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11
Q

Hematologic System

When does the fetal hemoglobin phenomenom disappear?

A

In first few weeks

with physiologic anemia occurring at 2-3 months

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12
Q

Hematologic System

When does Physiologic anemia occur?

A

Physiologic anemia occurring at 2-3 months

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13
Q

Hematologic System

How does Physiologic anemia (@ 2-3 mo) manifest?

A

Hgb falls to normal levels of 10-11 g/dl

Hgb remains at physiologic anemia levels until early teens

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14
Q

Oxygen-Hemoglobin Equilibrium

Newborn have a high concentration of HgbF (70-80%). How does newborn Hgb affinity to O2 compare to adult Hgb affinity to O2?

A

New born Hgb affinity to O2 (P50 of 18-20) is higher than adult Hgb affinity to O2 (P50 of 27)

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15
Q

Oxygen-Hemoglobin Equilibrium

How does higher Hgb affinity to O2 affect the Oxygen-Hemoglobin dissociation curve?

A

Shifts the Oxygen-Hemoglobin dissociation curve to the left

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16
Q

Oxygen-Hemoglobin Equilibrium

At what age is HgbF replaced by adult Hgb?

A

During the first 3 months of life, and

the P50 then equals that of adults

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17
Q

Oxygen-Hemoglobin Equilibrium

At what age does the P50 reaches its peak? What’s peak values of P50? How long does P50 remains at peak?

A

By 9 months of age,

the P50 reaches its peak of 29-30mmHg

where it remains until puberty

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18
Q

Oxygen-Hemoglobin Equilibrium

During which developmental period is O2 delivery enhanced?

A

During the busiest growth period of the pediatric pt’s life

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19
Q

Renal Function

T/F: The concentrating capacity of an infant’s kidney is less than that of an adult

A

True

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20
Q

Renal Function

In response to water depravation, what can the kidneys of a term infant do?

A

Increase the osmolarity of urine to a maximum of

600-700 mOsm/kg

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21
Q

Renal Function

In response to water depravation, the kidneys of a term infant can increase the osmolarity of urine to a maximum of

A

600-700 mOsm/kg

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22
Q

Renal Function

In response to water depravation, the kidneys of a term infant can increase the osmolarity of urine to a maximum of 600-700 mOsm/kg. In contrast, maximum urine osmolality in adults is:

A

1200 mOsm/kg

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23
Q

Renal Function

Variations in the release of which hormone regulates the osmolality of the extracellular fluid?

A

Variations in the release of AntiDiuretic Hormone (ADH) regulates the osmolality of the extracellular fluid

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24
Q

Renal Function

T/F: Although dehydrated newborns cannot concentrate urine as efficicently as adults can, free water clearance is greater in infants than adults

A

True

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25
Q

Renal Function

After a free water load, infants can excrete a markedly diluted urine of up to

A

50 mOsm/kg

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26
Q

Renal Function

After a free water load, infants can excrete a markedly diluted urine of up to 50 mOsm/kg. In contrast the maximally diluted urine an adult can produce is:

A

70-100 mOsm/kg

This leads to impaired ability to handle a water load and clear drugs

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27
Q

Renal Function

Overall, how is GFR?

A

Overall, there is a ↓ GFR

GFR is 15-30% of normal adult value

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28
Q

Renal Function

By 1 month, how is GFR changed? At what age is the adult GFR reached?

A

GFR becomes 70% of mature GFR by 1mos

And the Adult GFR value is reached by 1yr

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29
Q

Renal Function

Why is there ineffective concentrating ability until 6-12 mos

A

Limited renal tubular function

Resulting in ineffective concentrating ability until 6-12 mos

30
Q

Renal Function

What’s the cause of the Limited renal tubular function that results in ineffective concentrating ability until 6-12 mos?

A

Hypotonicity of the adrenal medulla

31
Q

Renal Function

Why do they have normal “acidosis”?

A

Decreased reabsorptive function

Loss HCO3 = which leads them to having a normal “acidosis”

32
Q

Renal Function

Why are they prone to hyponatremia/hypovolemia?

A

Decreased reabsorptive function

Makes them Obligated Na+ losers = which makes them prone to hyponatremia/hypovolemia

This is why IVF should contain Na+

33
Q

Renal Function

What’s the Net renal function effect?

A

Impaired ability to handle (hold on to) a saline & water load

(They will not reabsorb it! or they will just loose it!!!)

This affects the Renal clearance of drugs

This also affects how drug metabolites are diminished

34
Q

Endocrine System

With the endocrine system, what do we monitor?

A

Hypoglycemia

35
Q

Endocrine System

How is Hypoglycemia defined for older children?

A

BG < 40 mg/dl

36
Q

Endocrine System

How is Hypoglycemia defined for neonates?

A

BG < 30 mg/dl

37
Q

Endocrine System

Why are Premature infants at greatest risk for Hypoglycemia?

A

Small for gestational age

Infants of diabetic mothers

38
Q

Endocrine System

Why are Infants of diabetic mothers at greatest risk for Hypoglycemia?

A

B/c they have been Exposed to ↑ levels maternal glucose throughout the pregnacy

With that, they have an automatic response which is to ↑ their levels of insulin

39
Q

Endocrine System

T/F: Hypocalcemia is common in premature neonates and small for gestational age infants

A

True

40
Q

Endocrine System

Hypocalcemia is common in premature neonates and small for gestational age infants. What are the causes of this phenomenom?

A

Decreased stores

Lack of exogenous supply

Parathyroid immaturity

Inadequate vitamin D stores

Asphyxiation

Offspring DM

Transfused with citrated blood

41
Q

Endocrine System

Why are infants predisposed to hypocalcemic hypotension?

A

Myocardial contractility more dependent on extracellular Ca2+ due to immature myocardial sarcoplasmic reticulum

42
Q

Hepatobiliary System

Why may drugs metabolized by P-450 system have a prolonged half-lives?

A

Liver enzyme systems are immature in the infant

Particularly those involved in phase II (conjugation) reactions

43
Q

Hepatobiliary System

Why do you need to know which drugs you are administering that are highly protein bound?

A

Infants also have ↓plasma albumin levels at birth

This results in ↓ protein binding of some drugs

You must know the Pharmacologicals effect of ↓ protein binding of some drugs

44
Q

Gastrointestinal System

Why is there a higher incidence gastric reflux?

A

Incompetent LES

Prolonged gastric emptying

Uncoordinated swallowing/respiration until 4-5mos

Upper abdominal disorders, which causes vomiting

Lower abdominal disorders, which causes abdominal distention (failure to pass meconium)

45
Q

Gastrointestinal System

Uncoordinated swallowing/respiration until how old?

A

4-5mos

46
Q

Gastrointestinal System

Upper abdominal disorders, which causes

A

Vomiting

47
Q

Gastrointestinal System

Lower abdominal disorders, which causes

A

Abdominal distention

(failure to pass meconium)

48
Q

Gastrointestinal System

What’s infant Gastric pH immediately after birth?

A

Alkalotic

49
Q

Gastrointestinal System

When does infant Gastric pH reaches Normal adult range?

A

by 2nd day life

50
Q

Thermoregulation

Infants are Highly susceptible to hypothermia, why?

A

Large BSA to weight ratio

Thin layers of insulating fat

Increased metabolic rate

Limited stores of brown fat

Poor central thermoregulation

51
Q

Thermoregulation

Why can’t infants compensate for cold by shivering?

A

Central thermoregulation is poor

52
Q

Thermoregulation

What’s the Principle method of heat production for infants/newborns

A

Nonshivering thermogenesis or Brown fat metabolism

53
Q

Thermoregulation

T/F: The metabolism of Brown fat is severely limited in the premature infant and sick neonate

A

True

54
Q

Thermoregulation

T/F: (Inaudible) anesthetic inhibits thermogenesis and brown adipocytes

A

True

55
Q

Thermoregulation

Where is Brown fat is stored?

A

Intrascapulary space

Around large vessels

In the neck

Around the sternum

Around the kidneys and the adrenals

56
Q

Thermoregulation

T/F: Cool temperatures and anesthetic agents can convert newborns/infants to poikilotherm

A

True…

57
Q

Thermoregulation

What’s a poikilotherm?

A

An organism that cannot regulate its body temperature except by behavioral means such as basking or burrowing

58
Q

Thermoregulation

How we can reduce heat loss in these pts?

A

By limiting temperature gradient between patient & environment

59
Q

Thermoregulation

What are the routes of heat loss?

A

Radiation

Conduction

Evaporation

60
Q

Thermoregulation

Via which route do infants lose most of their heat?

A

Radiation

61
Q

Thermoregulation

How do you reduce heat loss via radiation (route infants lose most of their heat)?

A

Warm OR to 28-30 C

Double-shelled Isolette for transport

Radiant warmer

62
Q

Thermoregulation

How do you reduce heat loss via Conduction?

A

Place infant on warming mattress

63
Q

Thermoregulation

How do you reduce heat loss via Evaporation?

A

Humidified gases

Warm fluids

Warm-air blankets

64
Q

Central Nervous System

The Brain represents what proportion of the body weight?

A

Brain is 1/10th of the body weight

65
Q

Central Nervous System - Spinal cord development

In the Embryo, the spinal cord occupies:

A

Entire spinal canal

66
Q

Central Nervous System - Spinal cord development

At birth where is the lower end of cord?

A

At L3 level

67
Q

Central Nervous System - Spinal cord development

By 1 year of age, where is the end of the cord?

A

At the level of L1 (adult level)

68
Q

Central Nervous System - Spinal cord development

As vertebral column grows, spinal nerve roots are drawn into spinal canal. Which structure emerges from this?

A

Cauda equina

69
Q

Central Nervous System - Spinal cord development

Why is testing primitive reflexes (Moro, grasp, Babinski) a useful tool when assessing neuronal development?

A

Primitive reflexes (Moro, grasp, Babinski) should disappear as myelination occurs

70
Q

Central Nervous System - Spinal cord development

When do Primitive reflexes (Moro, grasp, Babinski) disappear? Why?

A

Primitive reflexes (Moro, grasp, Babinski) disappear as myelination occurs

Myelination is not complete until 3rd year of life

8361 Exam 2 (20 decks)

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