, enuresis, thirsty through night, constipation, dehydration, hypernatremia, in infants- irritable, only soothed by water, drink out of toilet DX: water deprivation test, elevated Na, 24 hr urine collection (↓ urine osmolality, ↓ spec grav) TX: desmopressin, wt monitoring, 1L = 1 kg, I&O, education, med alert bracelet SIADH : increased ADH, excessive fluids, acute CC: inf, tumor, CNS disease, trauma S&S: water intoxication, decrease to no UOP, hyponatremia, N&V, seizures, malaise, mental status changes, urine concentration DX: high urine osmo, high urine spec grav, low serum osmo & serum Na, decreased BUN & hct TX: underlying cause, careful I&O, wt monitoring, fluid restriction, hypertonic NaCL (central line), seizure precautions, edu, diet high in protein and Na, frequent neuro checks Thyroid Function: pituitary gland, TSH, thyroid gland, Thyroxine (T4), & Triiodothyronine (T3), calcitonin Hypothyroid : low T3, T4, high TSH, congenital or acquired S&S: Congenital- thick, protruding tongue, hypotonic, bradycardia, larger posterior fontanel, prolonged neonatal jaundice, difficulty feeding, hypothermia Acquired- decreased appetite, thinning hair, bradycardia, depressed reflexes, slow growth, fatigue, constipation, cold sensitivity DX: newborn screen, TSH level, thyroid scan or ultrasound, bone age x ray TX: levothyroixing, dose adjustments with growth, apical pulses & BP prior to admin, give in am, toxicity- same as hyperthyroidism, pt educate, plotting growth Hyperthryoid (Graves D): overproduction of TH, autoimmune, ages 12-14 yrs, familial S&S: exophthalmos, goiter, behavior issues, irritability, restlessness, diff to relax or sleep, fatigue, tachycardia, high BP, increased appetite, wt loss, heat intolerance DX: elevated serum T3 & T4, low or undetectable TSH levels TX: anti- thyroid meds, BB, radioactive iodine therapy, surgery to remove nodule Cushings : excessive cortisol, adrenal tumor, pituitary dysfunction- excessive ACTH, uncommon in kids S&S: hyperkalemia, hyperglycemia, hypertension, infections, fatigue, muscle wasting, round moon shaped face, fat pad btwn shoulder pads, stretch marks on abdomen, mood changes, growth delay, irregular or absent menses DX: 24 hr urine for cortisol & 17- hydroxycorticosteroid, saliva cortisol, serum glucose, cortisol & electrolytes, imaging of pituitary & adrenals TX: adrenalectomy, educate pts on cortisol replacement, stress with illness, fever, trauma, surgery- increase dose Congenital Adrenal Hyperplasia (CAH): cortisol deficiency, increased ACTH, adrenal hyperplasia, excess androgens, ambiguous genitalia S&S: boys- no manifestations until later in child, early pubic hair, enlarged penis, increased rate of physical growth, advanced bone age girl- ambiguous genitalia at birth, penis, enlarged clitoris, fusion of labia leads to sac like appearance- looks like scrotum, internal sexual organs- normal, genetically female (XX)- infertility risk, no breast development DX: abnormal levels of ACTH & cortisol, 17- hydroxyprogesterone on newborn screen, chromosomal analysis to determine gender, replace deficient hormones TX: replace hormones, PO glucocorticoids (cortisol), dose individualized, hormone dose must be doubled or tripled during acute
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