Pediatrics Flash Cards - Case 16 - 7yo Abd pain and vomiting

Question 1

Cushing’s triad

Answer 1

seen in pts w/ ICP: HTN (w/ wide pulse P), bradycardia and abnl resps (Cheyne-Stokes Resps)

Question 2

Four ways to dx DM?

Answer 2

random BG > 200 w/ sx [OR] fasting BG > 126 [OR] s/p glucose load 2 hr BG > 200 [OR] A1c > 6.5 (adults only)

Question 3

Dx criteria for DKA?

Answer 3

Diabetic (random BS > 200) PLUS Keto (Mod-to-large keton-uria or -emia) PLUS Acidosis (venous pH < 7.3 or bicarb < 15 mEq/L)

Question 4

Insulin drip dose for child in DKA?

Answer 4

0.1U/kg/hr

Question 5

Start-up labs for DKA?

Answer 5

blood glucose, UA, blood gas, lytes (incl Ca++, Mg++, Phos), serum osmolarity, CBC w/ diff, serum beta-hydroxybutyric acids if available + ANTIBODIES (Anti-pancreatic incl insulin, GAD, & IA2, anti-thyroid and Anti-endomysial & TTG w/ [IgA])

Question 6

Early EKG sign of hyperkalemia?

Answer 6

peaked T waves

Question 7

What sodium/osmolarity range is considered isotonic for rehydration purposes? If in this range, how quickly can you re-hydrate?

Answer 7

Na+ or Serum osmolarity of 130 to 150; can re-hydrate over 12 hrs

Question 8

What sodium range is considered hypotonic for rehydration purposes? If in this range, how quickly can you re-hydrate? If too quick you cause ___?

Answer 8

Na+ or serum osmolarity < 130; rehydrate over 24 hrs; central pontine myelinolysis

Question 9

What sodium range is considered hypertonic for rehydration purposes? If in this range, how quickly can you re-hydrate?

Answer 9

Na+ or Serum osmolarity (including in DKA) > 150; rehydrate SLOWLY, over 48 hours; most deadly -> cerebral edema

Question 10

Which solutions are usually used to provide maintenance fluids?

Answer 10

0.25% or 0.45% saline w/ 5-10% dextrose

Question 11

Maintenance fluid dosing?

Answer 11

approximately 2.0 mL/kg/hr for children < 15 kg and 1.0 mL/kg/hr for children > 15 kg and adults

Question 12

Calculation for pre-illness weight

Answer 12

Pre-illness weight = Current weight / [(100 – % dehydrated) x 0.01]

Question 13

Admission orders mnemonic?

Answer 13

ADC VANDISMAL: A =Admit to (floor, room, service, attending, resident) | D=Dx (by priority) | C=Condition (good, fair, guarded, critical) | V=Vitals | A=Activity | N=Nursing (I&Os, drains, wound care, etc) | D=Diet | I=IV fluids (type/rate) S=Studies | M=Meds (incl prn’s) A=Allergies | L=Labs

Question 14

When do kids w/ DM1 typically enter the honeymoon phase?

Answer 14

1 month after dx

Question 15

Basal-bolus dosing regimen for DM1?

Answer 15

50% as ultra-long acting (e.g. glargine) QHS + 50% as fast-acting in 3 divided doses w/ meals

Question 16

Which kids should get screened for DM2 per ADA starting at 10y/o (or puberty) then q3 yrs?

Answer 16

Overwt (BMI >85th %ile) PLUS 2+: mDM2/GDM during preg; FMHx in 1st or 2nd degree rel; Race/ethnicity; S/Sx insulin resist.

Question 17

Single most helpful sign is distinguishing appendicitis in children? Others?

Answer 17

Fever (both sensitive and specific); midabd pain migrating to RLQ incr likelihood; WBC < 10k and ANC < 6750 both decr likelihood

Question 18

Administration of … to treat DKA is linked w/ incr risk of cerebral edema.

Answer 18

bicarb DON’T DO IT, IDIOT!

Question 19

Sodium (Na+) and Potassium (K+) changes in DKA?

Answer 19

Low Na+ ( hyperosmolarity of intravascular space from incr gluc -> osmotic movt into extracellular space. Also, incr renal Na+ loss; normal or High K+ (lack on insulin causes K+ to leave cells)