Tuesday, August 27, 2013

1. Insulin requirements in a:
-prepubertal child: 0.5-0.7 units/kg/day: half given as long-acting "baseline" insulin such as lantus, and half given as a short-acting "bolus" insulin before meals such as novalog.
-pubertal child: 1-1.2 u/kg/day. Puberty is a time of growth, and sex-hormones also create a degree of insulin resistance.
2. Goal blood sugar: 80-140 in kids (even though non-diabetic kids run 60-100), 200s in babies. You really don't want kids running hypoglycemic, since its such a critical time for brain development/growth, you'd rather run high sugars than low.
3. 1800 rule: 1800/(total insulin daily dose units) = number of glucose units one unit of insulin will drop your blood sugar, if your sugar is over 150. For example, if you are aiming for a goal sugar of 125, and you are currently at 225, and your normal daily dose is 36 units/day, then 1800/36=50, so one unit of insulin will drop you 50 points, so you need 2 units of insulin-- assuming you are not about to eat a meal, in which case you will also need to correct for the sugars you plan on ingesting. This rule breaks down a little at very high blood sugar levels-- insulin is less effective then, and you will need more.
4. If you have ketones in your blood, that means you do not have enough insulin. 
-small amount of ketones: bolus +5% of your total daily dose of insulin on top of whatever correction
-medium amount of ketones: +10%
-large amount: +15%
5. When correcting blood sugars, assuming you have calculated the correct dose of insulin to give, wait 2 hours before checking your sugars again and giving more correction, if needed. Do not give lots of insulin in a short period of time. With insulin, its always better to start lower and titrate up.
6. For emergency fluid resuscitation, it's good to use a short, fat line-- i.e. a jugular venous line, rather than a longer line like a femoral.
7. Diagnosing wheezing in a child:
-Asthma: +viral trigger, +responds to albuterol, +history of atopy
-VIW/RAD: +viral trigger, +responds to albuterol, no history of atopy
-Bronchiolitis: +viral trigger, doesn't respond to albuterol, no history of atopy
8. Usually asthma is not diagnosed until someone is 3-4 years old, because of the frequency of RAD/VIW in children. Generally, kids who just have VIW will grow out of it by age 4-5 That being said, if a young kid has been hospitalized more than 4 times in the last year for wheezing/difficulty breathing and they have a personal of atopy and a family history of asthma, they need BID inhaled corticosteroids whether you want to call it asthma or not.
9. Most common causes of headache in pediatric populations: migraine/tension headaches, ICP (2/2 tumor/bleed), pesudotumor cerebri
10. Sunscreen needs to be applied 15-60 minutes before sun exposure because it needs time to form a protective film across your skin.

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