paeds endo

Question 1

Signs and symptoms of DKA

Answer 1

Presentation:
- N+V
- abdo pain
- reduced GCS

on questioning:
- polyuria, enuresis and nocturia + polydipsia
- weight loss
- failure to thrive

Question 2

Investigations and immediate management

Answer 2

ON ARRIVAL
Height and weight
vital signs
urinalysis
BM and ketones
VBG

ON DIAGNOSIS
- A-E approach, call senior and admit with 1-1 nursing

• fluid BOLUS 10ml/kg or 10ml/kg if shocked over 30 mins
• calculate fluid DEFICIT
  mild-mod DKA (pH 7.1-7.29)- 5% x body wieght
  severe DKA (pH <7.1) - 10% x BW
  not shocked: deficit - bolus over 48hrs
  shocked: deficit over 48hrs
• MAINTENANCE
  1000ml first 10kg
  500ml second 10kg
  20ml for every remaining Kg
  over 24hrs

ALL FLUIDS WITH 400mmol/L KCl (unles anuric or hyperK+)

• INSULIN (after 1-2hrs fluids)
  0.05U/Kg/hr - incrase to 0.1U/Kg/kr if unresponsive after 6hrs
• add 5% dextose when BM <14mmol/L

MONITOR
- 2hrly: BM, ketones, U&Es, VBG
- continuous: ECG, GCS, urine output (catheter), vital signs

Question 3

Managament/counselling of newly diagnosed T1DM

Answer 3

MDT approach: endocrinologist, paediatrician, diabetic nurse, dietician

what is it:
-T1DM is a type of diabetes diagnosed commonly at a young age
- it is when the body doesnt produce a vital hormone (called insulin) which enables our cells to use glucose
- this is because there is damage to the organ that makes this hormone by our immune system
- it is a life long condition and requires injections to replace this hormone

RISKS:
- if left untreated it can have very serious consequences on the body- most importantly the brain wont be able to use glucose –> death

what to do now:
- same day referral to an endocrinologist
- referral to diabetic nurse
- check BM, ketones –> A&E if signs of DKA
EDUCATION: diet and exercise, SN for DKA and hypo symptoms, diabetes UK support groups

What this means in the future:
- insulin injections life long
- 4x/year clinics
- screening for organ damage and other autoimmune conditions
-

Question 4

Causes of precocious puberty

Answer 4

gonadal dependent:
- brain tumour
- brain trauma
- idiopathic

gonadal independent:
- McCune albright syndrome
- CAH (21-OH/ 11b-OH def)
- tumours (leydig- sertoli, theca cell)
- exogenous hormones eg COCP

Question 5

investigations for precocious puberty

Answer 5

1. bone age scan
2. LH/FH levels
3. GnRH stimulation test
4. genitalia examination
5. 21-OH/ 11bOH levels

Question 6

Mx of precocious puberty

Answer 6

• reassure if idiopathic
• treat any cause
• gonadotrophin dependent: GnRH agonist and GH agonist
• independent: specialist referral

Question 7

causes of delayed puberty

Answer 7

idiopathic

hypogonadotrophic hypogonadism:
- brain trauma
- brain tumour
- Kallmans syndrome

hypergonadotrophic hypogonadism
- Turners
- 17xOH def CAH
- hypothyroidism
- gonadal damage

Question 8

causes of short stature

Answer 8

short parents
genetic: turners, downs, PWS, noonans
endocrine: GH deficiency, hypothyroidism, cushings
dispropotionalte: rickets, spinal dysplasia
chronic illness: IBD, coeliac, CF, anorexia