Multiprofessional Critical Care Review: Pediatric 2024 (MCCRCP24ON)-Endocrine Issues In The PICU Highlight

Endocrine Issues In The PICU Highlight

Pdf Summary

The document titled "Endocrine Issues In The PICU" by Dr. Jerry J. Zimmerman addresses various endocrine disorders and their management in the Pediatric Intensive Care Unit (PICU). Dr. Zimmerman has disclosed research funding from NIH/NICHD and Immunexpress, and royalties from Elsevier.<br /><br />The key topics discussed in the document include:<br />1. **Consequences of Insulin Deficiency**: Insufficient insulin leads to unrestrained gluconeogenesis causing muscle catabolism and hyperglycemia. The body switches to fatty acids, resulting in ketoacid production and dehydration due to hyperglycemia and hyperosmolality.<br /><br />2. **Diabetic Ketoacidosis (DKA) Treatment**: The document outlines a treatment protocol for DKA which includes fluid resuscitation to restore renal perfusion, insulin administration, electrolyte replacement, addressing the precipitant of DKA, and monitoring complications like hypoglycemia and cerebral edema.<br /><br />3. **Hyperglycemia Hyperosmolar Syndrome vs. Diabetic Ketoacidosis**: It provides a comparison of various variables such as serum glucose, bicarbonate levels, serum osmolality, blood pH, and presence of ketones.<br /><br />4. **Adrenal Insufficiency**: This section includes conditions like congenital adrenal hyperplasia, Addison’s disease, and other causes linked to the loss of hypothalamic-pituitary-adrenal (HPA) axis integrity.<br /><br />5. **Renal-Angiotensin-Aldosterone System**: Details the physiology and pathophysiology involving angiotensin II, highlighting its role in increasing systemic vascular resistance, blood pressure, aldosterone release, and mediating cardiac hypertrophy.<br /><br />6. **Pheochromocytoma**: This condition is characterized by hypertension, tachycardia, headaches, and other systemic symptoms. Diagnosis involves analysis of catecholamine metabolites, while treatment includes alpha and beta-adrenergic blockades and surgical resection.<br /><br />7. **Thyroid Disorders**: <br />   - **Sick Euthyroid Syndrome**: Discusses laboratory markers, noting variations in free T4, T3, and TSH levels.<br />   - **Hypothyroidism**: Lists causes like Hashimoto thyroiditis, post-ablation, iodine deficiency, and medication effects.<br />   - **Hyperthyroidism**: Commonly caused by Graves’ disease, toxic multinodular goiter, and amiodarone-associated thyroiditis.<br /><br />8. **Thyroid Storm Management**: Highlights inhibition of thyroid hormone secretion, blocking hormones in peripheral tissues, treating precipitating events, managing systemic decompensation, and using measures like plasmapheresis and radioiodine therapy.<br /><br />These endocrine issues and their management protocols are clinically relevant for the care of critically ill pediatric patients in the PICU.

Keywords

Endocrine Disorders

PICU

Insulin Deficiency

Diabetic Ketoacidosis

Adrenal Insufficiency

Renal-Angiotensin-Aldosterone System

Pheochromocytoma

Thyroid Disorders

Thyroid Storm

Pediatric Critical Care

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