Insufficient insulin means: - HIGH blood glucose - high ketone production

Endocrinology Flashcards by Laura Lazzari

What antibodies occur in T1DM?

anti-GAD
anti-islet cell
anti-insulin

How well did you know this?

Not at all

Perfectly

What are symptoms of T1DM in a child

polyuria
polydipsia
Weight loss
Nocturnal enuresis

How well did you know this?

Not at all

Perfectly

What is the late presentation of T1DM?

DKA 
- smell of acetone on breath 
GI sx: 
- vomiting 
- dehydration 
- abdo pain 
Other: 
- Kussmaul breathing 
- Hypovolaemic shock 
- Drowsiness 
- Coma

How well did you know this?

Not at all

Perfectly

What skin features indicate T1DM

Acanthosis nigricans

Skin tags

How well did you know this?

Not at all

Perfectly

How is T1DM diagnosed?

Urine dip: glycosuria, ketonuria
Random blood glucose >11.1mmol/L
Fasting glucose: >7mmol/L
High HbA1c: >48

OGTT rarely required

How well did you know this?

Not at all

Perfectly

Why does DKA occur?

Insufficient insulin means:

HIGH blood glucose
high ketone production

How well did you know this?

Not at all

Perfectly

How does insulin affect ketones in a normal person

If person eats meal > blood glucose high > insulin immediately produced > insulin SWITCHES OFF KETONE PRODUCTION as unnecessary

How well did you know this?

Not at all

Perfectly

What are the effects of high blood glucose and ketones in a child?

Glucose: osmotically active > polyuria, polydipsia

Ketones: acidotic environment > enzyme dysfunction> coma, death

How well did you know this?

Not at all

Perfectly

What is the aim of DKA treatment

Rehydrate FIRST

Switch off ketone production AFTER

How well did you know this?

Not at all

Perfectly

how do you calculate fluid deficit in a child?

total deficit volume = % deficit x weight x 10

% deficit is 5% if pH >7.2
7% if pH = 7.15
10% if pH <7.1

How well did you know this?

Not at all

Perfectly

How long should you replace fluid deficit over in DKA, and why?

Over 48h

To avoid cerebral oedema

How well did you know this?

Not at all

Perfectly

How do you manage DKA in a child?

FLUID BOLUS: 10ml/kg NaCl (if in shock, double)
Start insulin infusion after 1h
Once blood glucose <14 mmol/L, switch to 4% dextrose to avoid hypoglycaemia

How well did you know this?

Not at all

Perfectly

why is. hypoglycaemia common in neonates?

Due to high energy requirements

Poor glucose. reserves

How well did you know this?

Not at all

Perfectly

What is hypoglycaemia in neonates

Plasma glucose <2.6mmol/l

How well did you know this?

Not at all

Perfectly

What are clinical features of hypoglycaemia

swearting
pallor
CNS signs of irritability (headache, seizure, coma)

How well did you know this?

Not at all

Perfectly

What are complications of hypoglycaemia

Epilepsy
Severe learning difficulty
Microcephaly

How well did you know this?

Not at all

Perfectly

WHat are causes of hypoglycaemia beyond neonatal period

Insulin excess:

exogenous insulin
Drug induced (sulphonylurea)
Insulinoma (beta cell tumour)
AI
Beckwith-Wiedemann

Without insulin excess:

Liver disease
-Ketotic hypoglycaemia of childhood (following period of starvation, due to poor glucose reserves)
Error of metabolism

How well did you know this?

Not at all

Perfectly

What is management of hypoglycaemia if child is conscious

fast acting glucose 40% gel e.g. Glucogel

How well did you know this?

Not at all

Perfectly

What is management of hypoglycaemia if child is unconscious

IM glucagon

IV glucose infusion (5ml/kg of 10ml bolus)

How well did you know this?

Not at all

Perfectly

What are causes of congenittal hypothyroidism?

maldescent of thyroid
Iodine deficiency
TSH deficiency
dyshormonogenesis (error of thyroid hormone synthesis)

How well did you know this?

Not at all

Perfectly

what is the most common cause of congenital adrenal hyperplasia

21 hydroxylase deficiency

How well did you know this?

Not at all

Perfectly

what is the normal function of 21 hydroxylase in the adrenal?

converts progesterone to aldosterone

converts 17-hydroxyprogesterone to cortisol

How well did you know this?

Not at all

Perfectly

what occurs to hormones in CAH

Lack of Aldosterone and COrtisol

EXCESS of androgens !!

How well did you know this?

Not at all

Perfectly

what is the presentation of acute CAH

virilisation of external genitalia in female

clitoral hypertrophy
fusion of labia

excess virilisation in males:

enlarged penis
pigmented scrotum

SALT LOSING ADRENAL CRISIS:

vomiting
hypotonia
circulatory collapse

How well did you know this?

Not at all

Perfectly

what is the presentation of a partial CAH

tall stature, muscular build, adult bodu opdour, pubic hair, acne precocious puberty

What investigation should you get if suspecting CAH

17alpha-hydroxyprogesterone: ELEVATED MASSIVELY

what biochem abnormalities occur in salt losers:

low sodium high potassium metabolic acidosis hypoglycaemia

How do you manage an adrenal crisis in CAH

IV saline IV dextrose IV hydrocortisone 200mg

What do you do for females with CAH specifically

corrective surgery for external genitalia | definitive surgery usually delayed until puberty

what is long term management for CAH

- Lifelong glucocorticoid (hydrocortisone) - mineralocorticoid (fludrocortisone) if salt loss - Monitor growth, skeletal maturity, plasma androgens, 17alpha hydroxyprogesterone - Additional hormone replacement at times of illness

when should you start thyroxine tx in congenital hypothyroid

within 2-3 weeks of age | to reduce risk of impaired neurodevelopment

what is treatment of congenital hypothyroid

Thyroxine replacement | LIfelong

How can you measure fluid deficit in child with DKA

if pH>7.1: MODERATE DKA so fluid deficit = 5% if pH <7.1: SEVERE DKA so fluid deficit =10%

what is the formula to calculate fluid deficit in children

% deficit x 10 x weight (kg)

How do you treat DKA if child is alert, not nauseated or vomiting, not clincially dehydrated

oral fluids | SC insulin

when do you treat DKA with IV fluids and IV insulin

in children who are not alert nauseated / voming dehydrated

what is IV fluid bolus in DKA

if shocked: 20ml/kg of 0.9%NaCL | if not shocked: 10ml/kg of 0.9%NaCl

How do you calculate total fluid requirement after bolus

maintainance + deficit

what is fluid maintainance in DKA

<10kg: 2ml/kg/h 10-40kg: 1ml/kg/h 40+kg: 40ml/h

what fluid do you give for DKA

0.9% NaCl WITHOUT dextrose until plasma glucose <14mmol/L THEN change to 0.9% NaCl + 5%dextrose after plasma glucose is BELOW 14mmol/L

when do you start K+ replacement in DKA

as soon as urine is passed

When do you start insulin infusion in DKA

1-2h after starting IV fluid therapu

what is the IV insulin infusion dose you should give

0.05-0.1 U/kg/h

what is K+ replacement in DKA

40mmol/L KCl in solution you are giving

what order should you think of giving things in DKA ?

FLUIDS > INSULIN > POTASSIUM

when can you change from IV insulin to subcut insulin

when ketosis is resolving, child is alert, child can take oral fluids wtihout nausea/vomiting

when can you STOP IV insulin

Min 30 mins after starting SC insulin | Min 60 mins after staarting insulin pump

what should you be monitoring during DKA therapy

Capillary blood glucose Vital signs Fluid balance (input and output chart) Level of consciousness (using modified GCS) EVERY HOUR

What continuous monitoring do you need to get in DKA

CONTINUOUS ECG if IV THERAPY FOR DKA becuase they may develop hypokalaemia

what is the biggest neuro risk in DKA

cerebral oedema

what are mild signs and symptoms of cerebral oedem

headache agitation, irritability unexpected fall in HR increased BP

how do you treat cerebral oedema

Mannitol OR hypertonic saline

what are severe signs of cerebral oedema

deteriorating consciousness abnormalities in breathing oculopmotos palsy pupillar abnormality

how do you manage hypokalaemia in DKA

consider stopping insuilin | discuss management with paeds critical care specialist

how do you treat hypoglycaemia in hospital

IV 10% glucose bolus (max 5ml/kg) followed by 10% glucose infusion

how do you treat hypoglycaemiaa in community

IM glucagon (500mcg <8years old, 1mg >8)

how does glucose cause cerebral oedema

HIGH GLUCOSE changes osmolar gradient causes water shift extracellularly

how do you prevent cerebral oedema when treating DKA

rehydrate gradually, over 48h | give less fluids than you would normally

How do you treat HYPERTHYROIDISM

Carbimazole / propilthiouracil (thionamides)

what are thionoamides associed with

risk of NEUTROPOENIA

what is management for T1DM

Insulin BASAL BOLUS regimen

Explain insulin basal bolus regimen

Long acting insulin (once/twice daily, typically in the morning) Short acting insulin before meals

Give 2 examples of long acting insulin

They both start with L! - Lantus - Levemir

Give 2 examples of short acting insulin

Actrapid | Novarapid

How is insulin in basal bolus regimen administered

Subcut

How is insulin administered if the patient is in hospital pre-surgery

Variable rate aka sliding scale IV

When is fixed rate IV insulin appropriate

in DKA

What is the difference between metformin and sulpholyurrea in terms of their ability to cause hypos, and how does that relate to their mechanism of action

Metformin increases sensitivity to insulin, therefore cannot cause hypo Sulphonylurea increases insulin quantity, so can cause hypo

what are the three therapy choices for treating GRAVES\

1. Carbimazole /PTU 2. Radioiodine 3. Surgery (thyroidectomy)

What is a contraindication for radioiodine

avoid in eye disease as it may cause worsening

what is risk of carbimazole

small risk of neutropoenia

what is risk of surgery in Graves

risk of damage to recurrent laryngeal nerve

Endocrinology Flashcards

(72 cards)