1. Criteria for admission for anorexia/bullemia: bradycardia (criteria says <50, but in reality it's low 30s), electrolyte imbalances, rapid weight loss.
2. Family centered counseling/therapy leads to 90% remission at 5 years.
3. Things to worry about in anorexia:
-electrolye abnormalities (hypokalemia/hyperchloremia from vomiting, hyponatremia)
-volume depletion (leading to decreased GFR, mitral valve prolapse)
-osteopenia/osteoporosis (can happen in first 6 mos of illness, can have life long consequences bc pt fails to reach maximum bone density)
-concomitant mental illness or substance abuse (i.e. OTC or illegal weight loss supplements)
4. Most drugstore OTC weight loss drugs contain caffeine as a major ingredient, because it's an appetite suppressant.
5. Grading for asthma:
-Intermittent: <2 days/week of symptoms and of rescue albuterol use, 0 nights a month (<5 years) or <2 nights/month (5+) of waking up at night with coughing/wheezing.
-Mild Persistent: 3-4 days/week of symptoms and of rescue albuterol use, 1-2 nights a month (<5 years) or 3-4 nights/month (5+) of waking up at night with coughing/wheezing
-Moderate Persistent: daily symptoms and of rescue albuterol use, 3-4 nights./month (<5 years) or >1 night/week (5+) of waking up at night.
-Severe Persistent: multiple times a day symptoms and rescue albuterol use, >1 night/week (<5 years) or nightly (5+) waking up at night.
6. First line for asthma controller medicine is inhaled corticosteroids (flovent). Often given 2x a day, morning and night. Use a spacer: kid breathes out, then you puff the inhaler, they either breathe in and out 6x or breathe in and hold their breath for 10 seconds-- the older kids can handle the latter.
7. If flovent alone fails to control the asthma, you can increase the dose or add a long acting beta agonist. Advair/symbacort are LABA+steroid. Montelukast (singulair) is especially helpful in kids who have a mix of asthma and allergies, with the allergies triggering the asthma. If the kid has a lot of upper respiratory swelling and inflammation (like swollen turbinates) you can add flonase (fluticasone nasal spray) to remedy that.
8. Most common cause of pediatric dialysis use is obstructive uropathy, in boys often secondary to persistent posterior urethral valve. Sometimes you can get tethered cord leading to neurogenic bladder, which can lead to obstructive uropathy. Once they are sick enough to need dialysis, usually they are on dialysis until they get a transplant.
9. You can transplant an adult kidney into a child-- there is space in the abdomen to fit it. The transplants will generally last decades. Some people/kids need heavy-hitting sets of immunosuppressants (steroids, calcineurin inhibitors, cellcept aka mycophenolate mofetil) while other people are ok with just a calcineurin inhibitor. There are some research groups out of san francisco figuring out blood tests to predict which people are in which group.
10. Having cats in the home at a very young age is associated with decreased future incidence of autoimmune disease.