P. 1
Study Notes Pediatrics

Study Notes Pediatrics


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Study Notes Pediatrics
Study Notes Pediatrics

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Published by: MedShare on Apr 01, 2010
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* 8yo boy is seen in the ED with vomiting and abdominal pain of two days duration. His mother states he has been
drinking a lot of fluids for the past month and reports weight loss during that time. Physical exam reveals a low-
grade fever and a moderately dehydrated boy who appears acutely ill. He is somnolent but asks for water.
Respirations are rapid and deep (Kussmaul respiration). Labs reveal metabolic acidosis and hyperglycemia.
* Diabetes mellitus results from a deficiency in insulin. It could be a defect in action and/or straight deficiency.
* There is abnormal carbohydrate metabolism as well as protein and fat metabolism because of that. The cells do not
get glucose so they start to break down other energy sources, such as fats leading to ketone body formation.
* Type I diabetes is insulin-dependent, severe lack of insulin, seen in children.

Study Notes – Pediatrics

James Lamberg



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* Type II diabetes is insulin-resistant, can be seen in older obese children and adults.
* Etiology is thought to be autoimmune, more common in patients with other autoimmune diseases, can be post-
viral, association with certain HLA antigens. Can run in families.
* Initial presentation in most children is diabetic ketoacidosis (DKA). This is an acute presentation with polyuria,
polydipsia, +/- polyphagia, and weight loss.
* Up to 25% present with DKA, vomiting, abdominal pain, moderate to severe dehydration, Kussmaul respirations,
lethargy, obtunded, thirst.
* DKA occurs when glucose is > 300 in blood, have ketonemia, and acidosis. Usually pH less than 7.3.
* DKA will come with ketonuria and glucosuria.
* Criteria is symptoms of diabetes, random blood sugar > 200, or fasting blood sugar > 126, or 2hr glucose tolerance
test > 200.
* Treatment for diabetes mellitus type 1 is insulin, diet, exercise.
* Treatment for DKA is fluids then insulin. Correct dehydration first.
* Diabetes complications include retinopathy, cataracts, nephropathy, neuropathy, most occurring in adults.

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