Endocrinology

Question 1

You are seeing a 3 week old who presents with lethargy and poor feeding, No history of fever. Vitals show tachycardia, no fever, no hypotension. Initial blood gas: 7.16/ Na 124 / K 7.3/ glc 1.0.

Describe 5 steps in the management of this patient.

Question 2

A 8yo child presents with lethargy, BP=80/40, HR = 160, T=36.8. His glucose is 35, urine ketones 4+. Write the exact initial fluid order. List 4 risks factors for the development of cerebral edema.

Question 3

Lab findings in CAH. Tx.

Answer 3

• Hyponatremia
• Hyperkalemia
• Hypoglycemia
• Metabolic acidosis
• Management:
  
  • Emergency glucocorticoid therapy to any patient with AI and temperature about 38.5, emesis/diarrhea, bony fracture of any type, altered mental status or shock
    
    • Patient appears ill: Hydrocortisone 50 mg/m2 IM or IV, followed by same dose divided by 4 and given every 6 hours
    • Patient not ill-appearing and tolerating oral fluids: home oral dose x 3, given in 3 equal parts daily OR hydrocortisone 50 mg/m2 orally in three divided doses
  • Hyperkalemia
    
    • Infants with CAH tolerate hyperkalemia remarkably well
    • Volume resuscitation with normal saline often only intervention required
    • 12 lead ECG
    • 10% calcium gluconate 1 cc/kg
    • Glucose and insulin contraindicated because of risk of hypoglycemia
    • Ventolin
    • Bicarbonate
    • HD/lasix/kayexalate
  • Hypoglycemia
    
    • D10 5 cc/kg and recheck blood glucose
    • D10NS maintenance following bolus
  • Acidosis
    
    • Bicarbonate reserved for severe acidosis (pH < 6.9 and cardiovascular compromise resistant to inotropic agents)

Fleisher’s 7th Ed Chapter 97 Endocrine Emergencies

Up To Date Treatment of classic congenital adrenal hyperplasia due to 21-hydroxylase deficiency in infants and children

Question 4

Endo. 2 year old with decreased LOC, glucose is 1. Stays down with iv dextrose bolus. Diagnosis?

Question 5

Picture of meningitis and hyponatermia 118 - name 2 further investigations to confirm the diagnosis and whether those investigations are increased or decreased

Question 6

manifestations of hypocalcemia.

Question 7

DKA - initial order in a hypotensive patient, 4-5 risk factors for cerebral edema

Answer 7

• Also:
• Severity of acidosis
• Failure of serum sodium to rise with fluid and insulin therapy indicates greater fall in serum osmolality
• Lower pCO2 (after correction for acidosis)
• Studies conflict in their conclusions of whether rate of insulin or fluid administration is associated with increased risk of cerebral edema.

Fleisher’s 7th Ed Chapter 97 Endocrine Emergencies

Up To Date Cerebral edema in children with diabetic ketoacidosis