CPEN Endocrine and Metabolic Emergencies

Question 1

A 12-year-old presents with polyuria, polydipsia, weight loss, and fruity breath. Blood glucose is 530 mg/dL, pH 7.16, and bicarbonate 9 mEq/L. After establishing IV access, what is the priority first intervention?

Accepted Answer

Begin IV fluid resuscitation with isotonic saline

Answer

In pediatric DKA, isotonic fluid resuscitation must precede insulin therapy. Administering insulin before adequate hydration risks worsening hypokalemia and hemodynamic instability. Sodium bicarbonate is not recommended in pediatric DKA due to risks of paradoxical CNS acidosis and cerebral edema. Insulin infusion begins only after fluids are running.

Question 2

A 3-week-old infant presents with prolonged jaundice, poor feeding, hypotonia, and a bulging anterior fontanelle. TSH is elevated at >150 mIU/L and free T4 is undetectable. What is the diagnosis?

Accepted Answer

Congenital hypothyroidism

Answer

Congenital hypothyroidism presents with prolonged jaundice, large fontanelles, poor feeding, hypotonia, and constipation. An extremely elevated TSH with undetectable T4 confirms the diagnosis. Early levothyroxine treatment is critical to prevent irreversible intellectual disability. This condition is targeted by newborn screening (heel-stick), but some infants present clinically before results return.

Question 3

A 6-year-old with type 1 diabetes is found unresponsive with a blood glucose of 24 mg/dL. IV access cannot be established. What is the most appropriate intervention?

Accepted Answer

Administer glucagon intramuscularly or intranasally

Answer

For severe hypoglycemia with altered consciousness when IV access is unavailable, glucagon (IM or intranasal) is the priority intervention. It stimulates hepatic glycogenolysis to raise blood glucose rapidly. Oral glucose gel is contraindicated in an unresponsive child due to aspiration risk. IO dextrose is a valid alternative but requires more setup time than glucagon IM/IN.

Question 4

A 14-year-old with known Addison's disease presents with severe weakness, hypotension unresponsive to IV fluid boluses, vomiting, and sodium of 126 mEq/L. She reports running out of her medications one week ago. What is the priority treatment?

Accepted Answer

Administer IV hydrocortisone immediately

Answer

Acute adrenal crisis (Addisonian crisis) is life-threatening adrenocortical failure presenting with fluid-refractory hypotension, hyponatremia, and hyperkalemia. IV hydrocortisone (stress-dose steroids) is the definitive treatment and must not be delayed. Vasopressors are adjunctive but will not reverse the crisis without steroid replacement. This patient's missed medications precipitated the crisis.

Question 5

A 7-year-old with a history of craniopharyngioma resection presents with urine output of 9 mL/kg/hr, extreme thirst, urine specific gravity of 1.001, and serum sodium of 160 mEq/L. What is the most likely diagnosis?

Accepted Answer

Diabetes insipidus

Answer

Diabetes insipidus (DI) results from deficiency of antidiuretic hormone (ADH), commonly occurring after cranial surgery or trauma. It presents with massive polyuria of very dilute urine (specific gravity ≤1.005), polydipsia, and hypernatremia. It differs from DM in that blood glucose is normal and there is no glycosuria. Treatment is desmopressin (DDAVP).

CPEN - Certified Pediatric Emergency Nurse Practice Test

CPEN - Certified Pediatric Emergency Nurse Practice Test

CPEN Endocrine and Metabolic Emergencies