Flashcards in Paeds endo, musc, neuro, misc Deck (283)
What is the most common cause of CAH?
Recall the signs and symptoms of CAH
Virilisation of external genitalia
What is the best initial investigation to do when there are ambiguous genitalia?
What is the confirmatory investigation used to diagnose CAH?
Raised plasma 17-alpha-hydroxyprogesterone - cannot do in a newborn
What sodium and potassium levels are seen in a salt losing crisis?
What is the surgical management option for CAH?
For girls there is corrective surgery at early puberty to make the genitalia look more female
What is the medical management for CAH?
Lifelong hydrocortisone and fludrocortisone
How should a salt-losing crisis be managed?
IV hydrocortisone, IV saline, IV dextrose
What is the 'classical triad' of symptoms in DM?
Polydipsia, polyuria, weight loss
Recall the diagnostic criteria for DM
1. Symptoms + fasting >7 OR random >11.1
2. No symptoms + fatsing >7 AND random >11.1
3. No symptoms + OGTT >11.1
4. HbA1c > 6.5%
What OGTT result is considered 'impaired' glucose tolerance?
What fasting glucose result is considered 'impaired' glucose tolerance?
Recall the 1st and 2nd line options for insulin therapy
1st line = multiple daily injection basal-bolus: injections of short-acting insulin before meals, with 1 or more separate daily injections of intermediate acting insulin or long acting insulin analogue
2nd line = continuous SC insulin infusion (pump)
Recall the names of 2 types of long acting insulin
Recall the names of 3 types of short acting insulin
Lispro, apart, glulisine
Why should site of SC insulin injection be regularly rotated in T1DM?
Avoidance of lipohypertrophy
What should cap glucose be when fasting and after meals?
After meals: 5-9
When does annual monitoring for retinopathy/ nephropathy/ neuropathy begin?
How is DKA managed?
1. Replace fluids: deficit + maintenance requirement
Deficit volume = weight in kg x 10 x 5% for mild-mod DKA, or 10% for severe DKA
Maintenance volume = LOWER for DKA, due to risk of cerebral oedema
<10kg = 2mls/kg/hr
10-40kg = 1ml/kg/hr
40+kg = 40mls/hr
2. After 1-2 hours, start insulin therapy - infuse at 0.05-0.1 units/kg/hour
What are the symptoms of HHS?
Weakness, leg cramps, visual disturbances
What is the best option for oral monotherapy in T2DM?
What medications can be added for tx-resistant T2DM?
Sulphonylureas (eg glibenclamide)
Alpha-glucosidase inhibitors (eg acarbose)
Recall the 2 possible biochemical definitions of DKA
1. Acidosis + bicarb <15
2. pH <7.3 + ketones >3
How is DKA biochemically classified as mild/ mod/ severe?
Mild = pH <7.3, mod = <7.2. sev = <7.1
Recall the volume of fluid resus needed in a DKA emergency?
If shocked: 20mls/kg bolus over 15 mins
If not shocked: 10mls/kg bolus over 60 mins
How should fluids be replaced following the initial emergency in DKA?
Fluid deficit = 5% if mild-mod DKA, 10% if severe DKA
Deficit volume = weight x 10 x deficit%
Fluid maintenance in DKA specifically:
What is the maintenance requirement of fluids in non-DKA situations?
First 10kg = 100mls/kg/day (4mls/kg/hour)
Next 10kg = +50mls/kg/day (2mls/kg/hour)
Every kg above 20kg = +20mls/kg/day (1ml/kg/hour)
Recall the % fluid deficit that correlates to each severity of DKA
Mild = 5%
Mod = 7%
Sev = 10%
Calculate the fluid requirement of a 20kg boy in DKA, with pH 7.15, who has already received a 10ml/kg bolus (200ml) over 60 mins
Calculation: (deficit x weight x 10) - initial, "shocked" bolus over 48 hours
Deficit if pH = 7.15 = 5% (7 x 20 x 10) = 1000
Initial bolus - 200: 1400-200 = 1200 over 48 hours
1200/48 = 25mls/ hour
Maintenance = (10 x 100) + (10 x 50) = 1500mls over 24 hours