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PAEDIATRICS > Poisoning and DKA > Flashcards

Poisoning and DKA Flashcards

1
Q

State 5 situations to suspect poisoning

A

Seizures
Altered mental state
Unexplained coma
Compromised CVS
Metabolic abnormality
Unstable patient

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2
Q

What to ask in history of poisoned child x5

A

Type and amount of substance
Time and route of exposure
Time of symptom onset
Past medical history
Known drug allergies

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3
Q

Most common types of agents in poisoning x6

A

Cosmetics
Analgesics
Foreign bodies
Plants
Self care products
Cleaning solutions

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4
Q

Routes of poisoning x5

A

Ingestion
Inhalation
Parenteral -through injections
Ocular and dermal exposure
Mucous membrane involvement

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5
Q

Ocular signs in poisoning and the causes x4

A

Miosis- organophosphates, muscarinic mushrooms
Mydriasis- antihistamines, cyclic antidepressants
Nystagmus- ethanol, phenytoin
Lacrimation- Organophosphates, irritant gas

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6
Q

Oral signs in poisoning and the causes x5

A

Burns and dysphagia- corrosives
Dry mouth- antihistamines and anticholinergics
Salivation- organophosphates, corrosives
Hematemesis- corrosives, NSAIDs

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7
Q

Causes of diaphoresis(sweating) and diarrhea in poisoning x3

A

Diaphoresis- Organophosphates, muscarinic mushrooms, aspirin
Diarrhea- Antimicrobials, iron, cholinergics

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8
Q

3 respiratory signs in poisoning and their causes 3x2

A

Increased - asiprin and CO
Decreased- alcohol, narcotics
Pulmonary edema- hydrocarbons and organophosphates

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9
Q

3 Cardiac signs in poisoning and their causes x2

A

Tachycardia- atropine, cyclic antidepressants
Bradycardia- B blockers, CA channel blockers
Hypotension- barbiturates, iron + above

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10
Q

CNS effects of poisoning 5x2

A

Ataxia- alcohol, narcotics
Coma- sedative, CO
Muscle rigidity - haloperidol, cyclic antidepressants
Muscle fasciculation- organophosphates, theophylline
Peripheral neuropathy- organophosphates

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11
Q

State 5 complications of poisoning

A

Coma
Toxicity
Seizures
Metabolic acidosis
GIT symptoms
Heart rhythm aberrations/diversions

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12
Q

Differential diagnosis for coma x5

A

Asphyxia
Meningitis
Encephalitis
Cerebral malaria
Cerebrovascular accident

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13
Q

Describe direct toxicity from hydrocarbons ingestion and aspiration

A

Emesis increases the risk of pulmonary toxicity
Hydrocarbons with low viscosity and surface tension increase the risk of aspiration pneumonia

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14
Q

State 2 positions to open the airway and the age group

A

Neutral- <1 year
Sniffing- >1 year

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15
Q

Airway assessment x3

A

Look- chest movement
Listen- air mvt and stridor
Feel- air mvt

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16
Q

State 4 signs of increased work of breathing

A

Nasal flaring
Head nodding
Chest wall indrawing
Unable to eat or breastfeed

17
Q

Management of shock x4

A

Stop bleeding
Give oxygen
Obtain IV access
Keep child warm

18
Q

Stage 4 signs of seizure or convulsions

A

Increased tone
Eyes deviated
Facial twitching
Abnormal repetitive movement

19
Q

State 5 triggers of DKA

A

Infarction
Infection
Intoxication
Intercurrent illness
Inappropriate withdrawal of insulin

20
Q

Describe 2 liver effects of low insulin in the blood

A

Increased lipolysis > FFA> increased ketogenesis in the liver
Increased glucose production > hyperglycemia

21
Q

Clinical features of DKA x5

A

Polyuria, polydipsia, abdominal pains, arrhythmias, N&V

22
Q

State 4 effects of high plasma insulin

A

Glucose uptake
Glucose oxidation
Protein and glycogen synthesis

23
Q

State 3 stress hormones secreted during insulinopaenia and their 2 functions

A

Glucagon, cortisol, epinephrine
1. To increase mobilization of energy source
2. Adapt individual to new circumstances

24
Q

State short term 4 effects of insulinopaenia

A

Hyperglycemia
Lipolysis/ impaired lipid synthesis
Production of ketone bodies
Glycosuria, ketonuria, cations in urine

25
Q

State 5 end effects of insulinopaenia

A

Acidosis
Hyperosmolarity
Progressive dehydration
Diminished cerebral oxygen utilization
Impaired consciousness and coma

26
Q

Describe electrolyte imbalance in DKA x3

A

Potassium- hypokalemia caused by increased K+ in ECF > excretion
Phosphate- buffering to increase renal excretion of H+
Sodium- osmotic diuresis + vomiting > dehydration

27
Q

3 signs of intravascular volume depletion

A

Tachycardia
Poor peripheral perfusion
Decreased skin turgor

28
Q

Define severe DKA x3

A

pH<7.15
CO2 <10
Kussmaul respirations, sleepy to depressed sensorium to coma

29
Q

2 reasons why RL is preferred instead of NS in DKA

A

NS contains Na which increases dehydration
RL contain K which corrects hypokalemia

30
Q

Present and absent processes in the liver when there is high plasma insulin x5

A

Glucose uptake
Glycogen synthesis
Lipogenesis
Absence of gluconeogenesis
Absence of ketogenesis

31
Q

State what happens in the liver when there’s no plasma insulin x5

A

Glucose production
Glycogenolysis
Absence of lipogenesis
Gluconeogenesis
Ketogenesis

32
Q

Complications of diabetes x3

A

Retinopathy
Renal dysfunction ie nephropathy
Hypertension and hypercholesterolemia

33
Q

When to use bicarbonate in DKA and 3 side effects

A

Only used in severe acidosis or symptomatic hyperkalemia
1. Crosses BBB and increases cns acidosis
2. Shifts oxyhemoglobin dissociation curve and causes hypoxia
3. Increased risk of cerebral edema

34
Q

Risk factors of cerebral edema in DKA x4

A

Higher initial BUN
Lower initial CO2
Low sodium
Treatment with bicarbonate

35
Q

How to monitor patients with DKA x4

A

Record and monitor fluid balance and lab results (initial and other )
Measure serum glucose every hour during treatment
Assess neurological and mental status at frequent intervals
Assess for cerebral edema if there’s headache or deterioration of mental status

36
Q

Autoimmune diseases associated with DM x4

A

Hashimoto thyroiditis
Type A gastritis
Celiac disease
Primary adrenal insufficiency

PAEDIATRICS (20 decks)

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