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Pediatrics 6

    1. Management
      1. medications: insulin (regular, NPH); glucagon (hypoglycemic emergency only)
      2. other: diet (carbohydrate counting, age-appropriate), activity levels
      3. blood glucose monitoring
    2. Concerns: "honeymoon period" and insulin regulation, compliance, sick day management, ketones
    3. Complications:
      1. DKA (diabetic ketoacidosis) or extreme hyperglycemia (blood sugar > 350 mg/dl)
        1. etiology: not enough or no insulin
        2. findings
          • fruity breath, decreased level of consciousness
          • nausea/vomiting, abdominal pain
          • 10 percent dehydration
          • increased urine output
          • Kussmaul's respirations
      2. management
        1. fluids; control the level of serum osmolality
        2. regular insulin (IV drips and then subcutaneous)
        3. frequent monitoring of blood glucose
        4. frequent monitoring of electrolytes; neuro checks
    4. Hypoglycemia:
      1. etiology: most common occurrence of insulin therapy and bursts of physical activity, without additional food or with missed meals.
      2. findings
        1. fatigue
        2. nervousness
        3. pallor
        4. sweating
        5. palpitations
        6. funger
        7. loss of coordination
        8. seizures
        9. coma
      3. management
        1. 10 to 15 mg of simple carbohydrate
        2. followed by complex carbohydrate such as slice of bread or crackers
        3. occasionally glucagon is prescribed
  1. Pediatric Gastrointestinal (illustration)
    1. Dehydration (illustration)
      1. Occurs when total output of fluid exceeds total intake
      2. Compared to adults, children
        1. are less able to concentrate urine
        2. as infants, they have immature kidney and immune-regulatory systems
        3. have a higher metabolic rate
        4. have more body surface in relation to body mass
        5. because more of body weight is fluid, children need more fluid and lose more urine per Kg of body weight
      3. Types of dehydration (serum sodium determines type)
        1. isotonic: occurs in conditions in which electrolyte and water deficits occur in balanced proportions
        2. hypotonic: occurs in conditions in which electrolyte deficit exceeds the water deficit
        3. hypertonic: occurs in conditions in which water loss exceeds electrolyte loss
      4. Pathophysiology
        1. decreased fluids and electrolytes from ECF (extracellular fluid)
        2. leads to eventual loss of fluid from ICF (intracellular fluid)
        3. cellular dysfunction, shock
      5. Complications
        1. fluid losses: monitor urine output and specific gravity
        2. electrolyte losses: monitor sodium, potassium, chloride, calcium
        3. acid-base disturbance: metabolic acidosis
      1. Findings of dehydratio
      1. Management of pediatric dehydration
        1. monitor the 4 first signs and 3 second signs of dehydration
        1. administer fluids (oral, NG, IV)
    2. Edema
      1. Definition: excess fluid swells interstitial tissues
      2. Etiology
        1. defect in homeostasis
        2. renal disease; liver disease; nephrotic syndrome
        3. starvation
        4. burns
        5. decreased colloidal oncotic (swelling) pressure
      3. Pathophysiology: increased venous pressure - increased capillary permeability, decreased plasma proteins; contributing to the edema may be obstructed lymph flow or sodium retention
        1. findings: pitting edema, increased heart rate
          1. can be localized or generalized swelling
          2. pitting edema - more common with localized
          3. increased heart rate
        2. management - treat underlying cause

    1. Vomiting
      1. Definition: forceful ejection of gastric contents through the mouth
      2. Etiology: infection, obstruction, allergy, psychological causes, motion sickness, neurologic lesions
      3. Pathophysiology
        1. cause stimulates emetic center of brain
        2. mechanism of vomiting involves antonomic nervous system:
          1. salivation, sweating
          2. pallor, increased heart rate
          3. contraction of stomach antrum & duodenum
        3. types of vomiting: regurgitation, forceful, projectile
      4. Management
        1. detect and treat the underlying cause
        2. prevent dehydration, electrolyte loss and acid-base disturbance
        3. provide anti-emetic medications