1
Q
HLA a/w DMT1
A
HLA DR3,4
2
Q
HLA a/w DMT1
A
HLA DR3,4
3
Q
decrease risk DMT1 HLA
A
HLA 2,5
4
Q
PC DMT1 triad
A
polyuria polydipsia weight loss \+ skin infections \+ secondary enuresis
5
Q
resting plasma glucose and sympt
A
11.1mmol/L
6
Q
FBG
A
7mmol/L
7
Q
HbA1c
A
8
Q
Regular
A
onset: 30-60minutes
take b4: 15-30minutes
duraiton: 8 hours
peak: 2-4 hours
9
Q
NPH
A
onset: 1-2 hours
peaks: 4-12 hours
10
Q
antibody a/w DMT1
A
GAD
11
Q
blood ketone levels in DKA
A
> 3 mmol/L
12
Q
diagnosis of DKA
A
- blood glucose
- blood ketones
- urea/ creatinine/ electro’s
- urinary ketones
- ECG/ K+ levels
- metabolic acidosis– blood gases
- weight
- trigger– culture blood/urine
13
Q
decrease risk DMT1 HLA
A
HLA 2,5
14
Q
PC DMT1 triad
A
polyuria polydipsia weight loss \+ skin infections \+ secondary enuresis
15
Q
resting plasma glucose and sympt
A
11.1mmol/L
16
Q
FBG
A
7mmol/L
17
Q
HbA1c
A
18
Q
Regular
A
onset: 30-60minutes
take b4: 15-30minutes
duraiton: 8 hours
peak: 2-4 hours
19
Q
NPH
A
onset: 1-2 hours
peaks: 4-12 hours
20
Q
antibody a/w DMT1
A
GAD
21
Q
blood ketone levels in DKA
A
> 3 mmol/L
22
Q
causes of congenital hypothyroidism
A
MCC= maldescent and athyrosis
dyshormonogenesis
MCC WORLDWIDE= iodine def
TSH deficiency= panyhypopit
23
Q
tx DKA
A
- fluids– slowly over 48-72hours
+ monitor fluid status
2……….insulin (after 1 hour of fluids), after 24hrs– blood glucose around 14mmol/L - potassium– ONCE URINE PASSED, monitor heart
- acidosis– self corrects,; only give bicarb if in shock
- re-establish oral fluids, sc insulin, diet [only stop IV insulin once oral given for 1 hour)
- ID and Tx underlying cause
24
Q
other autoimmune diseases associated with diabetes
A
celiac
hypothyroidism
addisons
25
monitoring for DMT1 complications
yearly:
- HTN
- kidneys-- microalbuminuria
- hypothyroidism
3 years:
- celiac screen
5 years:
- retinopathy/cataracts
26
permanent neuro sequelae of hypoglycaemia
1. epilepsy
2. developmental
3. microcephaly
27
causes of hypoglycaemia - insulin XS
1. OD
2. nesidioblastosis/ insulinoma
3. autoimmune Ab to receptor
4. beck with syndrome
5. sulphonylureas
28
causes of hypolgycaemia- no insulin XS
1. liver disease
2. ketotic hypoglycaemia of childhood
3. glycogen storage disorder
4. hormonal def-- GH, ACTH
29
causes of hypoglycaemia= reactive
1. galactosemia
2. fructose intolerance
3. leucine sensitivity
4. hormonal def
5. alcohol or aspirin poisoning
6. maternal diabetes
30
Diagnosis of hypoglycaemia
CONFIRM BLOOD GLUCOSE
| --- then run through the labs specific to the numerous causes
31
Tx of hypoglycaemia from weird causes
1. glucose 10% ml/kg dextrose, followed by 10% dextrose infusion
2. IM glucagon
3. corticosteroids-- hypopituitarism, hypoadrenalism
32
thyroid hormones kids
fetal= reverse T3= inactive
| at birth SURGE TSH, then decreases, normalises at 1 week
33
causes of congenital hypothyroidism
MCC= maldescent
dyshormonogenesis
MCC WORLDWIDE= iodine def
TSH deficiency= panyhypopit
34
PC juvenile hypothyroidism/ acquired
- goitre
- loss of eyebrow hair
- coarse skin
- dry hair
- cold
- bradycardia
neurodevelopment decreased
- decrease reflexes
SUFE
obesity
35
juvenile hypothyrodism a/w which two syndromes
DOWNS
TURNERS
36
what autoimmune diseases a/w juvenile hypothyroidism
```
V.RAD
vitiligo
RA
addisons
DM
```
37
difference in presentation of hyperthyroidism in kids
NO EYE SIGNS
38
Two NB bone things for hyperthyroidism in kids
rapid growth height
| advanced bone maturity
39
true or false, maternal TSI antibodies can cross the placenta
TRUE! IgG
40
causes of hypoparathyroidism
1. preme- common
2. DiGeorge
3. Addisons-- older
4. McCune Albright syndrome
41
McCune Albright Syndrome
- cafe au lait
- endocrine-- precocious puberty
- bone problems
- obesity
- subcutaneous nodules
- 4th metacarpal
42
PC hypoparathyroidism
- spasms
- fits
- paraesthesia
- diarrhea
- irritable
- chovstek/ troussea
43
Tx hypoparathyrodism
1. calcium gluconate-- slowly increase
| 2. chronic: calcium, vit D
44
Hyperparathyroidism PC
- constipation
- anorexia
- behavioural change
- polyuria
- polydipsia
- bone erosions of phalanges
- lethargy
45
Hyperparaythroidism in neonate/young
Williams
46
Hyperparaythoidism in oder kid
MEN 1/ 2A
47
diagnosis of adrenal crisis
1. labs
2. decrease cortisol
3. increase ACTH
4. SynACTHen test
48
treatment of acute adrenal insuficiency
1. IV saline
2. IV hydrocortisone
3. IV glucose
49
treatment of chronic adrenal insufficiency
long term
- glucocorticoids (X3 if sick or surgery)
- mineralcorticoids
50
MAIN CAUSE OF CUSHINGS IN KIDS
STEROID USE-- long term
51
diagnosis of cushings
1. 24hours urine cortisol
2. dexamethasone
3. CT/MRI (Adenoma)
52
tx cushings
UNDERLYING CAUSE
1. steroids
2. adrenalectomy + Rtx
3. transsphenoidal + Rtx
PAEDS SC1
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