Endocrinology Flashcards
(57 cards)
define DKA
pH <7.3 or plasma HCO3- <15
and
blood ketones >3mmol/l
- sometimes: blood glucose >11mmol/l
cause of death DKA children
cerebral oedema (maj)
hypokalaemia
aspiration pneumonia (ileus or gastric paresis)
risk of DKA in patient per year
1-10%
DKA pathophysiology
absolute deficiency of insulin…counter rise in glucagon, cortisol, catecholamines and GH…increased gluconeogenesis…raises blood glucose and breakdown of fatty tissue…increased ketones…hyperglycaemia causes an osmotic diuresis…polyuric and pt becomes dehydrated + vomiting = worsening acidosis and dehydration
DKA risk factors
non compliance with insulin
device failure
changing insulin requirement during puberty
increased ingestion of glucose
infection
clinical features DKA
mean duration of 16.5 days of sx
- generally unwell
- lethargic
- N+V
- abdo pain
- headache and irritability
- confusion
examination DKA
deep, sighing breathing (kussmaul breathing)
tachypnoea
subcostal and intercostal recession
shock
dehydration
abdo pain
ketotic breath
signs of neurological compromise (cerebral oedema) DKA
irritability
slowing pulse
hypertension
reduced conscious level
papilloedema
DKA ddx
hyperosmolar hyperglycaemic state (no ketone production nor acidosis)
new presentation of type 1 SM
sepsis
appendicitis
DKA severity
mild - venous pH 7.20-7.29 or HCO3 <15
mod - 7.10-7.19 or <10
severe - <7.10 or <5
DKA management
A-E assessment
children in shock :
initial bolus - 20ml/kg of 0.9% NaCl over 15 mins
ongoing fluids - up to 40ml/kg total
children not in shock:
initial - 10ml/kg over 1 hr
ongoing fluids - calculate fluid deficit based on % dehydration (subtract initial bolus from this and add maintenance)
DKA - not clinically dehyrdrated and not vomiting
oral fluids and subcut insulin
but most will require IV fluids and insulin infusion (insulin should be delayed for 1-2 hours after IV fluid therapy). Dose of 0.05-0.1 units/kg/hr of soluble insulin
DKA fluids
resus fluids - given as bolus when in shock
deficit fluids - calculated from assumed dehydration. if bolus given for pt who is NOT IN SHOCK (subtract from this), DONT if pt is in shock
maintenance - 100 ml/kg/d for first 10 kg, 50 ml/kg/d for next 10 kg, 20ml/kg/day thereafter up to 80 kg
IMPORTANT to give 0.9% NaCl with 20mmol K in each 500ml bag. however if in AKI - anuric, so may result in hyperkalaemia - not administer K until urine passed
DKA resolved
clinically well
drinking and tolerate fluids
blood ketones <1mmol/l or pH normal
…then stop tx one hour later
hyperthyroidism prevalence
higher in girls and increasing age
neonatal thyrotoxicosis with mothers who have autoimmune hyperthyroidism
causes of hyperthyroidism
Grave’s
toxic multinodular goitre
toxic adenoma
thyroid carcinoma
neonatal hyperthyroidism
hCG-secreting tumours
functioning pituitary adenoma
risk fx of hyperthyroidism
family hx
personal or fhx of autoimmune disease
increase iodine intake
smoking (thyroid eye disease!)
female
hyperthyroidism ddx
transient thyroiditis
hashimotos (hashitoxicosis)
eating disorder
DM
phaeochromocytoma
neonatal thyrotoxicosis
if mother has grave’s - baby has TFT done between day 5-14 to check TFT
grave’s management childreb
carbimazole as propylthiouracil as increased s/e
administer via titration or block with higher dose and then replacement levothyroxine is given
NICE - titrating for 2 years and stop to see if gone into remission
s/e of anti-thyroid drugs
rashes, nausea
agranulocytosis
hepatitis
acute pancreatitis
neonatal hyperthyroidism management
self limiting within 1-3 mths, may require tx with propranolol or carbimazole
radioactive iodine therapy
not recommended <6 yrs old or with active eye disease or severely uncontrolled hyperthyroidism
total thyroidectomy
indications - <6 yrs old, etc
