Renal Week III Flashcards
Define Proteinuria
urinary protein excretion of more than 150 mg/day
Persistent proteinuria
as 1+ protein on a standard dipstick, two or more times during a 3-month period. This has to be investigated.
The most accurate way to measure proteinuria
24 hour urine
Most common symptom of bladder CA
Hematuria
When to screen for proteinuria in pregnant women
after 24 weeks- needs to be referred, sent to OBGYN, this due to risk of pre eclampsia
What tests to run when you find proteinuria > 150 mg/day
Test urine for :
Urine Dipstick
Urine analysis ( C&S)
24-hour urine collection (or spot protein/creatinine)
urinary sediment
Test Blood for:
CBC w diff, Lipids
renal function tests
fasting glucose and HgA1C
What can cause proteinuria > 150 mg/day
Glomerulonephritis
Hepatitis induced vasculitisis
Urate-related renal disease
Diabetes
drugs used to treat proteinuria
ACE/ARBS- reduces interglomerular pressure
Lifestyle changes to reduce proteinuria
sodium and protein-restricted diets
What can cause Hematuria DD
Drugs (anticoagulants) , Diet, Physical Activity, UTIs, Malignancies, Nephropathies
RBC casts seen via Urinalysis indicate what?
injury to the nephron
Colicky flank/ABD pain with hematuria, NV, increased urinary frequency
Renal stones
Gross hematuria
CA, cystitis, urethritis
Workup for hematuria
Pelvic/Prostate exam
Urine specimen (via cath) for UA, C&S, Cytology
sediment analysis
Imaging:
IVU, US, CT scan, Cystoscopy
Blood draw for:
CBC diff, PTT/INR
Kidney function tests: BUN, Creatinine
Hematuria management
Identify the problem, urological referral, surgery
Risk for renal stones
Diet (high salt, calcium) dehydration, sedentary lifestyle, family hx, gout, hyperparathyroidism
Conservative acute management of stones
Oral hydration, pain management, expectant stone passage
Lab testing for kidney stones
UA, C&S, Urinary PH, 24 hour urine collection, CBC, Serum calcium, Vit D levels
Imaging for kidney stones
KUB x ray, IVP US, CT
Size of stones to refer
> 6-8mm
Criteria for nephrotic syndrome
3-3.5 g of protein in urine/day- refer
What are the elements of a urinary analysis
Dipstick, Microscopy
Proteinuria after prolonged standing
orthostatic proteinuria - repeat test 24/r urine
DX for orthostatic proteinuria
3x negative results of early morning proteinuria- benign conditoon
Why do we check lipids for proteinuria?
client with proteinuria and hyperlipidemia should be aggressively managed to limit ESRD
the goal for tx of proteinuria
1 gram per day or less
When to refer for hematuria
gross frank blood, severe flank pain, unstable vitals, ss of urological obstruction
Glomerular causes of hematuria
Glomerulonephritis
Lupus Nephritis
Interstitial nephritis
pyelonephritis
vascultitis
non glomerular causes of hematuria
infection, cancer, renal stones, polycystic kidney disease, sickle cell, trauma, increased bleeding time, hemorrhagic cystitis
Hematuria and proteinuria with edema, HTN, HX of sore throat or skin infection
Post-infection glomerulonephritis
GFR criteria for kidney damage
GFR< 60mL
Normal kidney function GFR
GFR > 90
GFR Criteria for Kidney failure
GFR <15
the hallmark clinical signs of CKD and AKI
DEcreased GFR<90
Increased serum creatinine
Normal serum creatinine levels
Men 0.74-1.35
Women 0.59-1.04
Volume overload from kidney damage can cause…
irregular lung sounds, jugular vein distension, peripheral and central edema (ascities), extra heart sounds, increased fluid around heart AKA pericarditis
What stage of CKD do we refer to a nephrologist
Stage 4 CKD
GFR< 30
ACR >300 (albumin to creatinine ratio)
When do we refer to nepro when HTN is r/t kidney damage
HTN refractory to tx with 4 or more meds
Risk of starting ACE/ARBS for renal protection
Hyperkalemia ( high K+)
Metformin is contradicted with a GFR …
<30
Hematuria + Proteinuria, peripheral and central edema, tea-colored urine s/p infection
Post streptococcal glomerulonephritis
red/brow-colored urine 2+ heme but no RBC
hemoglobinuria or myoglobinuria
Most common cause of proteinuria in adolescent males
Orthostatic Proteinuria- benign, follow up 1 year
Edema, foamy urine, weight gain, fatigue, anorexia, tired
symptoms of nephrotic syndrome
treatment of nephrotic syndrome in children
oral steroids 2.5-3 months, diet (salt restriction), calcium & Vit D until urine is negative for protein
Treatment of nephrotic syndrome in adults
ACE, a statin for hyperlipidemia, anticoagulants, immunosuppression therapy
proteinuria, peripheral edema, and low serum albumin may indicate
nephrotic syndrome
Diagnosis of CKD
GFR <60 for 3 mths
Screening tests for CKD- done annually if at risk
Spot urine for albumin to creatinine ratio (ACR)
Serum creatinine to estimate GFR
UA
Serum cystatin C
risk factors for renal stones
obesity, family HX, dehydration, warm climates, animal products, high salt, high calcium
work up for kidney stones
constant pain may indicate obstruction, versus colicky, UA, C&S, CBC diff, PTH, CT scan US for prego or kids
What test should be monitored regularly in CKD
Parathyroid hormones= can cause hyper parathyroid
Serum lipids= can cause hyperlipidemia
Vit D, calcium, and phosphorus metabolism are all altered
Your patient has a butterfly rash and periorbital edema, what is in your differential
Lupus induced nephritis
What is a normal specific gravity
1.005-1.030
What is normal urine PH
4.6-8.0
Causes of kidney failure
NSAID use, DM, HTN, Family hx, 60+, race, hx AKD
most common cause of acute nephritis in children globally
Poststreptococcal glomerulonephritis
Testing for Poststreptococcal glomerulonephritis
Antistreptolysin O (ASO) titer
C3- will go down in 8 week
Poststreptococcal glomerulonephritis course of disease with labs
edema - 2 weeks
creatinine - 4 weeks
compliment 8 weeks
hematuria months
proteinuria 1 year
4 weeks s/p PSGN what would we see in labs?
Low c3, elevated ASO titer
Stages of kidney disease
Stage 1 normal GFR >90- with 1 other sign of kidney disease like proteinuria
Stage 2 GFR <60-89 with other signs
Stage 3a GFR 45-59
Stage 3b GFR 30-44
Stage 4 GFR 15-29- refer
Stage 5 GFR <15- refer
What is the definition of microscopic hematuria according to the American Urological
Association (AUA)?
Three or more red blood cells in a noncontaminated urinalysis without evidence of infection
dx of hematuria
3 RBCs or more per high-power field
child has failed to growth, increased thirst, and urination, muscle weakness irritability, acidic urine
renal tubular acidosis
HTN crisis refer to er with BP >
180/120 with ss of end-organ damage
Normal blood pressure
<120/80
elevated BP
120-129 and <80
Stage 1 HTN
130-139 and 80-89
Stage II HTN
140+ and 90+
How do we dx BP
2 separate office visit, at least 2 weeks apart
JNC 8 recommendations are to start Black patients on _____for HTN
dyhydropine CCB (e.g., amlodipine) and/or a thiazide diuretic.
Asian patients often do better when prescribed ______ for HTN
Calcium channel blocker or ARB
Non-Black patients should be started on _____ for HTN
thiazide diuretic, ACE inhibitor, angiotensin blocker, CCB, or combination
These HTN medications are recommended for any client with DM
Ace/ARBS are renal protectives (reduce blood flow through kidney)
The JNC 8 blood pressure goal recommendation for adults less than age 60
< 140/90;
BP goal for adults with confirmed HTN AND known CVD or 10-year ASCVS of 10% or higher
<130/80
The JNC 8 blood pressure goal recommendation for adults older than age 60
<150/90
The JNC 8 blood pressure goal recommendation for any adults with DM or CKD
<140/90
initial workup for HTN
H&P, CBC,UA, Glucose, BUN, Creatinine, Electrolytes, ECG, lipids
When to initiate drug therapy for obesity
BMI 30 or over with failed lifestyle changes - Orlistat
Obesity is a BMI greater than …
30
what age should patients be assessed for
cardiovascular risk factors and calculate
10-year risk of ASCVD
40-75
ACC/AHA guideline recommends moderate-to-high-intensity statin therapy starting at a 10-year ASCVD risk score of 7.5%
10% or greater
Risk factors for CAD coronary artery disease
Age, Gender, race, total cholesterol, hdl, ldl, BP, diabetes, smoking, tx for htn
When to start statins
40-75 with elevated lipids, LDL>130, HDL <40 and one other risk factor like DM, HTN Smoking, or >10% risk factor
Total cholesterol goal
<200
LDL
<100
HDL
> 60
Severe hypertriglyceridemia, elevated liver enzymes, chest pain, resp issue, rhabdomyolysis
Immediate ER
Who needs a fasting lipid panel and how often
adults older than 20 years, repeat every 5 years
Triglyceride goal
<150
Diseases that cause hyperlipidemia
hypothyroidism
diabetes
diseases that must be treated before starting statins
must get to euthyroid and control bs
labs to take before starting statins
liver enzymes- can cause liver damage
patient new on statin develops muscle pain, what lab should be drawn
CK to r/o rhabdo
discontinue statin if this is suspected
drug of choice for hyperlipidemia with liver disease
bile acid sequestrants
DX of metabolic syndrome
Waist >35-40
Triglycerides >150
HDL <40
BP> 130/85
Fasting glucose >100
A physical sign that is suggestive of moderate to severe insulin resistance is the hyperkeratotic condition
acanthosis nigricans.
impaired fasting glucose
100-126
When do we screen kids for hyperlipidemia
2+ with any risk factors like family hx and 9-11 routinely
tx of hyperlipidemia in children
lifestyle changes 1st then meds after 9 y/o - refer for med tx
PCP tx of HTN in kids
start checking 3 y/o start with lifestyle changes and refer if meds needed
Normal BP in kids
<90th percentile
stage 1 HTN in kids
> 95th - 99 percentile repeat 1-2 wks, take average over 3 visits
stage II HTN in kids
> 99 percentile- refer within 1 week
Dx secondary HTN ABCD
A-Accuracy, Apnea, Aldosterone
B-Bruits (renal artery), Bad Kidneys
C-Catecholamines (strees0, Coarctation or Aorta, Cushings syndrome
D-Drugs, Diet
E-Erythropoietin, Endocrine disorders
The client has elevated BP or stage 1 with an estimated 10 year ASCVD risk of <10% what do you recommend?
Lifestyle changes and come back in 3-6 months to see if its has worked
The client has stage 1 HTN and an estimated 10-year ASCVD risk greater than or equal o 10% when do you recommend?
in addition to lifestyle changes, 1 drug tx is recommended with a follow up in 1 month
The client has stage II HTN, in addition to lifestyle changes what do you recommend?
2 drygs from different classes with recheck in 1 months
The client has BP of 180/110
Give med in office and start woth 2 routine BP meds of different classes
work up for HTN
UA- check for hematuria/protienuria
(CMP)BUN, Creatinine, electrolytes - check kidney function
CBC- anemia erythropoietin kidney damage
Uric Acid - kidneys
Glucose- DM
Lipid Panel- Hyperlipidemia needs to treat more aggressively
ECG- LVH with wcs, ischemic heart disease
Moderate intensity statins
- Lovastatin 40-80
- Pravastatin 40-80
- Simvastatin 20-50
- Atorvastatin 10-20
- Rosuvastatin 5-10
high intensity statins
- Atorvastatin 40-80
- Rosuvastatin 20-40
Statin dosage for patients with clinical atherosclerotic cardiovascular disease
Atorvastatin 40-80
Rosuvastatin 20-40
Patients with severe high cholesterol LDL >190 regardless of other factors will get what kind of statin
high dose
atorvastatin 40-80
Rosuvastatin 20-40
Patients with DM and a LDL>70
Moderate
Pravastatin 40-80
Atorvastatin 10-20
Lovastatin 40-80
Simvastatin 20-50
Rosuvastatin 5-10
Patients 40-75 with and estimated risk of >7.5
Moderate
Pravastatin 40-80
Atorvastatin 10-20
Lovastatin 40-80
Simvastatin 20-50
Rosuvastatin 5-10
Avoid ace inhibitors in what population?
pregnant women
When does an ACE cough begin
Within 2 weeks of starting therapy
People taking an ACE inhibitor should avoid what?
Potassium - bc it already raises potassium risk of hyperkalemia
What is the 1st thing you should do if a client develops rhabdo with atorvastatin
stop the rhabdo 1st and then draw a CPK
What happens to SBP as you age
it gets higer
ASCVD risk is greater than or equal to 10% what is the blood pressure goal
<130/80
*What can a patient expect from adoption of the DASH diet?
Can lower your BP between 8-14mmh, like being on (1) med
Per 20 pound loss how much does BP drop
5-20 mmHg
Restricting sodium will drop BP how much
2-8mmhg
thiazide diuretic side effects
hypokalemia, low sodium, and hypercalciuria, make gout worse from dehydration, increased urination
Calcium Channel blockers side effects
flushing headaches, tachycardia, palpitations, dizziness, peripheral edema, gingival hyperplasia
ACE side effects
Dry cough, angioedema (can happen any time), do not take for child bearing age
ARB side effects
rashes, angioedema,
What anti hypertensive meds should be avoided with gout
hydrochorathiazide
What meds do we avoid with anyone with respiratory issues?
Beta-blockers- can cause bronchicontriction
Which of the following medications should be discontinued in a woman with essential hypertension who
is trying to get pregnant?
ACE/ARB- Losartan
What part of the lipid profile is most affected by not fasting
triglycerides, LDL
What test can we order if client does not want to fast for the test
Direct LDL
what is likely paired with a statin
bile acid sequestration- Ezetimibe
contraindication to statin
pregnancy, active liver disease
What is the mechanism of action of ezetimibe
Inhibits cholesterol absorption at the brush border of the small intestine
High TSH and Low T4
Hypothyroidism
Constipation, fatigue, weight gain, everything slows in body
Puffy/pale face/hair loss/weight gain/ diastolic hypertension / goiter
hypothyroid
Goiter with autoimmune hypothyroid
hashimotos
Diagnostic tests for thyroid
TSH- thyroid stimulating hormone - if abnormal order reflex..
Free T4
TPO Thyroid peroxidase antibodies- autoimmune
Antithyroglobulin antibodies
what thyroid test do you run to dx autoimmune thyroditis
TP0 Thyroid peroxidase antibodies
subclinical hypothyroidism
high TSH, normal T4
secondary hypothyroidism
normal TSH , low T4
The average dose of levothyroxine
1.6 mcg/kg/day
Levothyroxine teaching
take 1st thing in Am on an empty stomach, space out with other vitamins by 4 hours
levothyroxine requirements during pregnancy
dose should be increased by 20-30%
Subacute thyroiditis
thyroid is tender, hyper to hypothyroid - TX is NSAIDs
postpartum thyroiditis
3 mths after delivery - 40% develop hypothyroidism
most common cause of hyperthyroidism
graves disease- autoimmune
toxic multinodular goiter
palpate multiple nodules, excess tissue produces excess thyroid hormone, refer
Weight loss, fatigue, heat intolerance, tremors, anxiety
hyperthyroidism
exophthalmos, pre-tibial edema, clubbing of fingers and toes, vitiligo on the skin, thyroid bruit
graves disease
Graves disease dx
TSH suppressed, free T4, T3 elevated, Thyrotropin receptor antibodies +, ESR, CBC, LFT
graves, refer for tx including …
Methimazole, propylthiouracil, radioactive iodine, thyroidectomy, betablockers
Hyperthyroidism in 1st trimester
Propylthiouracil
Hyperthyroidism in 2nd trimester
methimazole
Thyroid storm - got to ER
fever, tachycardia, arrhythmias, CNS symptoms and GI symptoms
What do you order when you feel a thyroid nodule
order thyroid tests (TSH) and refer for a thyroid ultrasound
What is the management of Benign Nodules
repeat exam, US, TSH in 12 mths, if getting larger then fine needle aspiration, Surgery >4cm or symptomatic
A 20-year-old female patient with tachycardia and weight loss but no optic symptoms presents with the following laboratory values: decreased TSH, increased T3, and increased T4 and free T4. A pregnancy test is negative. What is the initial treatment for this patient?
Beta blocker medications
A female patient with hypothyroidism for the past 5 years presents for a positive home pregnancy test. She is taking levothyroxine 75 mcg daily and her TSH was 2.5 mIU/L six months ago at her routine physical. The nurse practitioner understands which of the following?
Thyroid requirements increase by 20-30% in pregnancy so she should have a TSH checked today
A patient has a thyroid nodule and the nurse practitioner suspects thyroid cancer. To evaluate thyroid nodules for potential malignancy, which test is performed?
Responses
Thyroid ultrasound
A postpartum woman develops fatigue, weight gain, and constipation. Laboratory values reveal elevated TSH and decreased T3 and T4 levels. What will the nurse practitioner tell this patient?
Responses
This condition may be transient.
hyperparathyroidism will increase_______ in the body?
Calcium
Cushing’s syndrome is caused by what
increased production of ACTH from the anterior pituitary, stimulating the adrenal cortex to produce more cortisol - long-term use of steroids
How to dx Cushing’s syndrome
24-hour free urine cortisol 2x
late night salivary cortisol 2x
low dose dexamethasone impression test
if positive refer to endocrinology - tx is surgery
A 25-year-old female patient presents with bilateral galactorrhea and irregular menses. She has a normal breast exam. In addition to checking a prolactin level, which of the following should be included in the initial work up?
Responses
Human chorionic gonadotropin (HCG)
Symptoms of hyperparathyroidism
cognitive impairment, Left ventricular hypertrophy, renal stones (from increased calcium)
A 40-year-old patient with primary hyperparathyroidism has increased serum calcium 0.5 mg/dL above normal without signs of nephrolithiasis. What is the recommended treatment for this patient?
Responses
Annual monitoring of calcium, creatinine, and bone density
Which of the following is true regarding Cushing disease?
Increased production of ACTH stimulates increased production of cortisol by the adrenal glands
Which laboratory values representing parathyroid hormone (PTH) and serum calcium are consistent with a diagnosis of primary hyperparathyroidism?
Inappropriate secretion of PTH along with hypercalcemia
Diabetic keto acidosis
Type I- ketones in urine, glucose 250-350, acidosis, admission to ER, PH < 7.3, Bicarb <15
HHS hyperglycemic, hyper osmolar syndrome
Type II- hyperosmolality (blood-like motor oil with sugar), dehydration, AMS, glucose 600+, PH > 7.3, Bicarb >15 HHS
New client with an A1C of 7.5, does he have DM?
Yes
The pathologic factors involved in type 2 diabetes in adults include:
Resistance to the effects of insulin at peripheral tissues and a relative insulin deficiency that is progressive over time
After Metformin if target A1C is still not met AND client has ASCVD (atherosclerosis)
GLP-1 end in “tide”
SGLT-2 end in “flozin”
“keep veins open with tide flozin”
Diabetic meds that lower weight
GLP-1 - end in tide
SGLT2 end in Flozin
Diagnostic criteria for DM
Random plasma glucose >200 With symptoms (1x)
A1C >6.5 (1X)
Fasting plasma glucose > 126 (2+x)
A1C to diagnose DM
A1C >6.5 (1x is ok)
Random fasting glucose to DX Diabetes
> 200 with symptoms (1x is ok)
What is the 1st thing your prescribe a client with new DM with a A1c of 6.5-7.5
Monotherapy- Metformin, GLP-1 - “Tide”
SGL T2 -“ Flozin”
What would you start a newly dx diabetic on with an A1C of >7.5
Duel therapy
oral med or insulin as second med
What do you start a new Dm client on that comes in with a A1C at 9 or higher WITH symptoms
Have to start right away with insulin, triple therapy
What do you start a new Dm client on that comes in with a A1C at 9 or higher WITH OUT symptoms
Can start with insulin, duel therapy
What is our Go TO for diabetic meds for CHF and CKD clients
SGLT 2- end with “flozin”
1st line- Basal Insulin dosing
Start with basal insulin, start low, go slow, increase units by 2 units every 3 days , lower dose by 10-20% of hypoglycemic
After Basal insulin what do we add if still not at goal?
Post prandial (AKA rapid acting insulin) start by giving dose with largest meal, about 4 units per day, Titrate dose by 1-2 units 2x per week, If still not at goal add for other meals
When do we screen for renal disease in type 2 dm
When they are 1st diagnosed
How do we screen for renal disease in DM?
ACR <30- have to do 3x. 2/3 are abnormal , that indicates kidney disease
What are thyroid drugs based on?
body weight
How to start thyroid meds
Start low, go slow, DO not start with max dose or can go into A fib
What is the best screen for diabetic nephropathy
ACR and GFR
How often do we screen for Nephropathy in a diabetic ?
Annually
How often to diabetics see the eye doctor
Annually
How quick does ACE work to protect kidneys ?
6-8 weeks
Hyperthyroid does what to bp?
Increases systolic and diastolic BP
Symptoms of type II DM may include..
Fungal and bacterial infections, new onset fatigue
When free T4 falls- what else happens?
TSH increases
What is the earliest glycemic abnormality in a patient with type II DM
post prandial hyperglycemia - glucose from food takes longer to go back to normal (Insulin not working) until it just remains elevated (insulin never works)
dark, velvety skin, looks dirty, does not itch or hurt
acanthosis nigricans- from constant high blood sugar
Asian BMI
> 23 is overweight
(25 everyone else)
Gestational DM is a risk factor for full blown DM (T/F)
True. 20% of women who have gestational DM develop type II DM.
Large baby is a risk factor for DM (T/F)
True
Triglycerides normal range
<250
What would make an hemoglobin A1C not accurate?
anemia
pregnancy
sickle cell
blood transfusions or blood loss
When do we start testing people for DM?
45 y/0
OR
Any age that are overweight with risk factors
OR
any high risk race
Anyone with a HX of giving birth to a baby over 9 pounds should be screened for DM (T/F)
True
What are criteria to test kids for DM?
Any BMI greater than 85th %
any kid that is overweight OR mom had gestational DM OR family HX of DM in 1st , 2nd relative, Symptoms of DM, Ethnicity is high risk
2 hour glucose tolerance test
> 200 without symptoms - has to come back and do it again
200 with symptoms, can dx with DM
How would you check between type I or type II DM?
DM I - you would see auto antibodies because its auto immune
Name (2) other autoimmune d/o you should check for with a dx of type I dm?
Hashimotos
Celiac
Type 1 DM
The presence of any one of these disorders should prompt testing of the other
When is metformin contraindicated?
GFR <30
What % of body weight should we ask to lose for lifestyle changes?
5%
(PA 30 minutes a day for 5 days a week)
How often do we check A1C in DM patients?
Every 3 mth until we meet goal then every 6 mths
All people over 26 y/o who are diabetics should be put on a statin (T/F)
Injectable DM meds
GLP-1
Insulins
Contraindications for metformin
GFR <30
Heavy alcohol use
Liver failure
Decompensated HF
Anyone who needs IV contrast - can not start metformin in 48 hours after IV contrast
How much of a reduction in A1c can you expect from Metformin
1-1.5%
Side effects of metformin
B12 deficiency
What organ does metformin work in?
Liver
(this is why its contradicted in liver disease)
What A1C % would you start duel therapy?
7.5 or greater
GLP-1 MOA
They kick the pancreas to stimulate insulin secretion
sulfonylureas MOA
They kick the pancreas to stimulate insulin secretion
TZD MOA
increase insulin sensitivity of muscle adipose tissue in LIVER
SGLT-2
(Jardiance)
Cause lots of UTI because they decrease kidney reabsorption and make you pee out glucose
DPP-4
(Januvia)
Slow down breakdown of GLP-1s that we already have
Metformin adverse affects
Diarreah for 2 weeks
can worsen heart failure
GLP-1 adverse effects
(Victoza)
Cause Nausea / vomiting
sulfonylureas adverse effects
(glipizide)
Kidney damage
decrease of GFR
Fractures
Weight gain
TZD adverse effects
Contradicted in people with intestinal disease, causes flatulence
DPP 4
(Januvia)
Weight Gain
How do we start dosing insulin
Start with long acting basal insulin and then add short acting if BS is still not controlled after meals
Long acting basal insulin names
Lantus
Levemir
glargine
Toujeo
What medication must you STOP when you start insulin
sulfonylureas
(glipizide)
Insulin dosing for A1C <8%
0.1-0.2 units per KG/DaY
Insulin dosing for A1C >8%
0.2-0.3 units per KG/Day
What hypoglycemia agency has been associated with weight loss
Metformin is associated with weight loss T/F
True
Rapid acting insulin (lispro, aspart) Onset, Peak, Duration
Onset 5-15min
Peak 1-2 hours
Duration 4-6 hours
Regular/Short acting Insulin
Onset, Peak, Duration
Onset 30 min
Peak 2-3 hours
Duration 3-6 hours
Intermediate acting Insulin Onset, peak, duration Rapid
Onset 2-4 hours
Peak 4-12 hours
Duration 12-18 hours
Long acting insulin
Onset, peak, duration
Onset 2 hours
Duration 24 hours
Nephropathy screening in DM in children
Start screening at 10 y/o, then annually spot urine ACR
OR once they had DM for 5 years
Eye screening for DM in children
Start screening at 10 y/o, then annually spot urine ACR
OR once they had DM for 5 years
DM foot screening in children
Start screening at 10 y/o, then annually spot urine ACR
OR once they had DM for 5 years
Lipid screening in DM children
10 y/o
when do you check for hashimoto and celiac for DM in children
at diagnosis
Infant has hypotonia, constipation, dry skin, open posterior fontanel, horse cry- what do you suspect?
Neonatal hypothyroidism- every baby gets screened at birth, bc sometimes there are no symptoms
Neonatal Synthroid dosing
10-15mcg/kg/day
Most common finding in a child with hypothyroid
a NORMAL exam
Lab value associated with subclinical hypothyroid
Elevated TSH and Normal T3
Lab value associated with hyperthyroid
Low TSH and high T4
treatment for hyperthyroid
thionamides, radioiodine, or surgery
in hyperthyroidism what would you see on a 24 hour radio iodine scan?
Increased uptake with homogenous pattern
