paediatric diabetes anD FTT

Question 1

what pH values indicate mild/mod and severe dehydration

Answer 1

> 7.1 mid mod

< 7.1 SEVERE

Question 2

what fluids are golem for fluid maintanence

Answer 2

0-9kg 1ml/kg
10-39 -2ml/kg
40 plus 40ml fixed
0.9% saline not 0.45% as that increase CO risk

Question 3

if shocked what

Answer 3

10ml/kg saline

Question 4

what is hourly rate calc

Answer 4

hr rale ml = maintenence + deficit (- bolus ) in 48 hours so divide by 48.

deficit= 10 x bw (kg) x dehydration
maintenance use values above and x 2 for 48 hour
remember to remove the bolus!

Question 5

insulin dose

Answer 5

0.1 unit /kg / heour

Question 6

what is cereal oedema signs

Answer 6

headache change in mental state/agitsation decrease GCS

and cushings tirad

Question 7

risk factors for c. oedema

Answer 7

younger age 
decreasing paco2 
new onset
low ph 7.1 
sodium imbalance
fast dehydration

Question 8

management with c.omedema

Answer 8

mannitol and restriction fluids

hypertonic saline

Question 9

things to counselling with diabetes in teens

Answer 9

life long
not alone, many thousands over uk
complications can be prevented if we can get under control
take little adjusting but most cope and lead normals lives
good to get into routine and habits
daunting but lots of experienced people can help you
support groups

Question 10

insulin

Answer 10

fast acting - rapid onset but short duration.
humalog, nororapid
short acting - 30-60 mins to work and had 8 hour coverage give before meals e.g. humbling, acttropraid

Question 11

regimen in kids

Answer 11

3 daily short acting with each meal

1 long acting in AM

Question 12

thing to advice regarding injections

Answer 12

pump
or subcut injection -> subcut, buttock, arm thigh, change sites , 40 degree pinch skin
monitor blood sugars 
aim for 4-10 in. kids
4-8 in teens 
carb count
30% fat intake
high fibre

Question 13

what is sick day

Answer 13

check heck check
ketones
hydration
unwell -> a & E

Question 14

what warrants admission on sick day

Answer 14

addition to monitoring blood glucose, you should check ketone levels when you are unwell, particularly if blood glucose is greater than 14mmol/l on 2 occasions.

If ketones are elevated (above 0.6mmol/L) and you have any of the following:

High Blood Glucose with excessive thirstiness/ passing urine
Dehydration
Vomiting or unable to tolerate oral fluid,
Abdominal pain
Breathlessness
OR

You are Pregnant