11683889
Description
Flashcards by Averil Tam, updated more than 1 year ago
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Created by Averil Tam
over 6 years ago
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| Question | Answer |
| TRUE/FALSE? 1. 4yo boy with known congenital adrenal insufficiency. 1/7 fever and diarrhoea. Not dehydrated, tolerating fluids by mouth. What is your advice? A. Increase his hydrocortisone to 3 to 4 times the usual maintenance dose (given in three or four divided doses). | True. Increase the dose of hydrocortisone in children with adrenal insufficiency during periods of heightened stress (intercurrent illness unless very mild, vomiting, diarrhoea, surgery, injury, anaesthesia). When the illness/stressful event settles, revert back to the maintenance dose of hydrocortisone. |
| TRUE/FALSE? 1. 4yo boy with known congenital adrenal insufficiency with 1/7 of fever and diarrhoea. Not dehydrated, tolerating fluids by mouth. What is your advice? B. Increase the dose of mineralocorticoid. | False. The dose of mineralocorticosteroid does not need to be increased during periods of illness/stress. |
| TRUE/FALSE? 1. 4yo boy with known congenital adrenal insufficiency with 1/7 of fever and diarrhoea. Not dehydrated, tolerating fluids by mouth. What is your advice? C. No increase in medication warranted as the child is only moderately unwell. | False. The dose of hydrocortisone must be increased during periods of illness unless the child is only mildly unwell. eg. a mild “cold” with no fever. |
| TRUE/FALSE? 1. 4yo boy with known congenital adrenal insufficiency with 1/7 of fever and diarrhoea. Not dehydrated, tolerating fluids by mouth. What is your advice? D. The child should be taken to ED if he develops vomiting and is not tolerating oral fluids or medication. | True. Children with adrenal insufficiency who cannot tolerate po will rapidly become glucocorticoid deficient, high risk of adrenal crisis (life threatening). Dehydration also a risk. Need urgent med review, IM or IV glucocorticoids and IV fluid replacement. Give IM hydrocortisone while awaiting transfer to hospital if needed. Parents of children with adrenal insufficiency are trained in IM admin of hydrocortisone and should have medication available at all times. |
| TRUE/FALSE? 2. In the situation of a baby born with a disorder of sex differentiation one must always consider the possibility of congenital adrenal hyperplasia. | True. Congenital adrenal hyperplasia may present as a disorder of sex development in a newborn. In the severe neonatal form it may result in an adrenal crisis and even death within weeks. |
| TRUE/FALSE? 3. Although a commonly used laboratory definition of hypoglycaemia is a blood glucose level below 2.6, symptoms are common at levels below 3.3 and this level should prompt consideration of further evaluation. | True. Hypoglycaemia is sometimes defined as a blood glucose level below 2.6 but most healthy infants and children maintain levels of 3.3 or above. Depending on the clinical circumstances, further evaluation should be considered with any BGL <3.3. |
| TRUE/FALSE? 4. A blood sample for investigation of hypoglycaemia in a child may, for practical reasons, be collected after stabilising the child and administering glucose. | False. Obtain a blood sample during the hypoglycaemic state to assess hormonal levels of insulin, growth hormone and cortisol during the episode eg. during IV cannulation. |
| TRUE/FALSE? 5. Hypocalcemia may present with seizures in the neonate or infant. | True. Seizures may be the presenting feature of hypocalcemia in the neonatal period or in infancy or rarely in an older child. Always check calcium levels in cases of seizures in this age group (as well as BGL). |
| TRUE/FALSE? 6. Neonatal thyrotoxicosis never presents in the first two weeks of life. | False. Neonatal thyrotoxicosis usually presents in the first week of life (but may occasionally be delayed) with tachycardia, irritability, diarrhoea, poor feeding, failure to gain weight and eye signs. If not recognised and managed it may be life threatening. |
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