Endocrine

Question 1

Neonatal hypoglycemia

Answer 1

Most common metabolic disorders in neonates

Question 2

DKA tx

Answer 2

BHOB best indicator of ketosis and resolution of DKA (inc pH dec BHOB)

Fluid:
Pediatrics 10-20ml/kg NS over 1 hr max 30-40ml/kg
Insulin- start after initial 20ml/kg bolus 0.1u/kg/hr until BHOB <1 (ketone marker)

Insulin replacement:
give glucose instead of stopping insulin if glucose falls too low

Electrolytes & Acidosis
Get rid of acidosis

Corrected sodium
Measured Na + [(serum glucose - 100 / 100] X 1.6
For every 100 of glucose over 100, sodium drops by 1.6

May give k+ phos

Ongoing Fluids 3 bag system
Bag 1 NS 20 meq KPhos
Bag 2 D10NS 20mEq KPhos
Bag 3 Insulin 0.05-1 u/kg/hr

Question 3

Thyroid storm rare

Answer 3

Acute life-threatening exacerbation of thyrotoxicosis
Symptoms: tachycardia widen, pulse pressure, hyperthermia organ system dysfunction
Clinical diagnosis: FT4 and T3 elevated, TSH suppressed

Demand for o2 exceeds supply- Anaerobic state

PTU is the tx
Do not give aspirin (inc level of circulating thyroid hormone)
Hydrocortisone stops conversion of t4 to t3

Question 4

Myxedema Coma rare

Answer 4

Extreme manifestation of hypothyroidism

Physical findings: hypertension, bradycardia, hypothermia, hypoglycemia failure to thrive

Treatment: levothyroxine replacement

Question 5

Congenital adrenal hyperplasia

Answer 5

Cortisol in aldosterone deficiency
Presents 2nd to 5th week of life
Signs and symptoms: lethargy, poor, feeding shock, brown hue, skin color
Treatment: IVF, steroid replacement, supportive care 

Question 6

Neonatal/ pediatric sepsis

Answer 6

Tx: airway, abx, vasopressors (norepi)
Hydrocortisone
Not rec to trend lactate

Question 7

Sickle cell

Answer 7

Autosomal recessive
At an Inc risk of infection bc damaged cells clogging spleen
Acute chest common, phon, asthma
Dactilitis- tender hands feet
Infection leading cause of death in sickle cell

Tx: o2, PRBCs, pain control, abx

Question 8

Diabetes insipidus

Answer 8

Disorder caused by deficiency of vasopressin (ADH)
affects water imbalance, kidneys, excrete large amount of dilute urine leading to dehydration and excessive thirst. Either brain doesn’t make enough ADH or kidneys don’t respond to ADH

Tx: hormone to replace ADH (DDAAVP) and IVF

Question 9

What would be the best choice to treat diabetes insipidus?
Aggressive diaries is using diuretics
Aggressive fluid management with DDAVP
Aggressive, correction of acidosis, using bicarbonate administration, and respiratory compensation
Aggressive glucose control with in

Answer 9

Aggressive fluid management with DDAVP (synthetic vasopressin)

Question 10

Which of the following laboratory findings would you expect to see in a patient with a diagnosis of SIADH

Dilutional hypercalcemia
Hypoglycemia
Hyperkalemia
Dilutional hyponatremia

Answer 10

Dilutional hyponatremia

Question 11

Based upon the diagnosis of a five-year-old pediatric with diabetes insipidus what lab findings would you anticipate?

1) Polyuria high serum osmolality, hypernatremia, low urine spec gravity
2) polyuria, low serum osmolality, hyponatremia, high urine spec gravity

Answer 11

1) Polyuria high serum osmolality, hypernatremia, low urine spec gravity

Question 12

You’re transferring a five year-old pediatric patient with a recent craniotomy to remove a tumor. They are currently awake alert answering your questions. There are no signs of neurological deficits. Vitals are currently BP 112/76 HR 88 RR22 SPO2 97% 2 L nasal cannula glucose 96. Since the craniotomy they have been urinating approximately 50 mils per hour within the last couple of hours. Urine output has increased to 350 mils per hour and has a specific gravity of 1.00 one. What would you suspect?

Hypervolemia
Diabetes insipidus
SIADH
Development of type two diabetes mellitus 

Answer 12

Diabetes Insipidus

Question 13

You’re treating a 10-year-old who is very lethargic only responsive to painful stimuli. They have history of type one diabetes mellitus and I’ve been sick with a virus for the past couple of days. When reviewing lab results what would you expect to find initially?

1) hyper glycemia hypokalemia acidosis elevated serum osmolality
2) hyperglycemia hyperkalemia, acidosis elevated serum osmolarity 

Answer 13

2) Hyperglycemia, hyperkalemia, acidosis, elevated serum osmolality