Paediatrics and Endocrinology Flashcards
how many children have type 1 diabetes
1 in 450
are more or less kids getting diagnosed with diabetes
more
what should you not expect in a child who is vomiting
them to keep peeing/ bedwetting as vomiting makes you dehydrated
think DKA
what are the signs of DKA in children
vomiting stomach pain sighing breathing ketones on breath altered consciousness pH<7.3
what are the signs of diabetes in children
increased drinking and peeing
bedwetting (especially if a child is usually dry at night)
weight loss
general malaise
(constipation, blurred vision. oral or vulval candida)
what are the diagnostic markers for diabetes in children
FBG >7 mmol/L
RBG >11 mmol/L
management for:
Elevated blood glucose*
No ketones
Clinically well
Urgent phone contact with
duty Paediatric team clinical
review arranged
within 24 hours
treatment for:
Elevated blood glucose*
Ketones present
Clinically well
Urgent phone referral to
duty Paediatric Team – same day review.
Treatment for: Elevated blood glucose* Ketones present Clinical symptoms/signs: • Abdominal pain • Vomiting • dehydration • Rapid and deep respirations (Kussmaul breathing) • Altered conscious level
Emergency referral to Paediatrics
what is the main different in treatment for DKA in kids
start fluid first carefully (1 hour) before starting insulin as risk of cerebral oedema
how does cerebral oedema happen
In DKA there is a high osmolar gradient (due to high BG) leading to fluid shift from ICF to ECF space and contraction of cell volume. If fluid is replaced rapidly this leads to a reversal of the osmolar gradient and causing rapid ICF volume expansion causing cerebral oedema
when do kids start attending microvascular screening
at age two
what age is diabetes especially hard to manage
teenage years- getting more independent, alcohol, risk taking, health no priority
what are the effects if poor diabetes control in children
social and emotional disruption
sub-optimal physical growth
biophysical changes of microvascular disease
what are the early changes of vascular disease in children with T1DM
Microalbuminuria cardiovascular autonomic neuropathy sensory nerve damage retinopathy cheiroarthropathy (thickened skin, joint contractures) skin vascular changes vascular endothelial pathology
what does tight glycaemic control increase the risk of
hypos
what type of insulin do pumps give you
continuous novorapid
what are the forms of congenital thryoid disease
primary- gland dysplasic +/- abnormal site (sublingual). inborn error of thyroid hormone metabolism
secondary/ tertiary- congenital pituitary disease, usually associated with hypopituitarism (GH< ACTH, gonadotrophin deficiency)
what are the symptoms of congenital thyroid disease
delayed jaundice
poor feeding but normal weight gain
hypotonia (umbilical hernia, constipation)
skin and hair changes
what is the screening for congenital thyroid disease
guthrie test (day 5)
capillary blood spot on to dry blotting paper
measurement of TSH and/or T4 levels
why does congenital thryoid disease nor affect foetus
as protected by placental thyroid hormones
what does absence of thyroxine after 3 months of age lead to
permanent developmental delay- cretinism
what are the causes of acquired thyroid disease in the young
delayed congenital post infectious autoimmune iodine deficiency and nutrition other autoimmune diseases (T1DM)
what are the features of hypothyroidism in children
often slow progress general growth failure, delayed puberty poor general heath educational difficulties goitre thyroid function tests (high TSH, low free T4 and T3 levels) high thyroid cell antibody titres
what is the treatment for hypothyroidism in kids
thyroxine for life
dose related to child size
what are the symptoms of hyperthyroidism in kids
behaviour problems, sleep disturbance, eating difficulties
goitre
high pulse rate
precocious puberty
what will test show in hyperthyroidism in kids
thyroid function tests (suppressed TSH, high free T4 and T3 levels)
high thyroid cell antibody titres
what is the therapy for hyperthyroidism in kids
initial therapy- beta blockade
suppressant therapy (first two years): carbimazole +/- thyroxine
permanent cure: radio-iodine, surgery
what are the primary causes of underactive adrenal disease in the young
adrenal hypoplasia (absent/ dysplastic/ destroyed)
inborn error of metabolism
congenital adrenal hyperplasia
what are the secondary causes of underactive adrenal disease in the young
pituitary disease (cong/acquired) suppression secondary to steroid therapy (high dose and prolonged)
what are the causes of overproduction of steroids (adrenal disease) in the young
cushing syndrome
- high dose cortical therapy
- cushing disease (primary adrenal, secondary pituitary)
what is produces by the adrenal cortex
mineralocorticoids aldosterone) glucocorticoids (cortisol) adrenal androgens (testosterone)
what is produced by the adrenal medulla
catecholamines- adrenaline and noradrenaline
what happens in congenital adrenal hyperplasia
21 hydroxylase enzyme is defective so aldosterone and cortisol aren’t produced and testosterone is produced in excess
what are the features of congenital adrenal hyperplasia
absent cortisol and aldosterone= ‘addison crisis’ (hyponatraemia, hyperkalaemia, hypotension)
excess testosterone= virilisation: female - ambiguous gentialia, male - precocious puberty
what is the treatment for addisons crisis
urgent therapy of salt and cortisol
what can be the DDX for ambiguous genitalia
CAH or other steroid abnormalities
gene and chromosomal abnormalities
congenital defects
