Important knowledge

⚡️Iron deficiency increase ⬆️ risk of febrile seizure

⚡️Side effects of GH (growth hormone ) ----------------------------- ▪︎increase in the risk for type 2 diabetes ▪︎pseudotumor cerebri ▪︎slipped capital femoral epiphysis ▪︎gynecomastia ▪︎coarsening of features ▪︎ worsening of scoliosis ▪︎ ⬆️risk of second neoplasms in cancer survivors

⚡️Criteria for stopping GH treatment in short stature : -------------------------- ▪︎ decision by the patient that he or she is tall enough ▪︎a growth rate <1 inch/yr ▪︎ bone age >14 yr in girls and >16 yr in boys.

⚡️Indications for Growth Hormone (GH) use in manegement of short stature in paediatric [ according to FDA ] ----------------------------------- ▪︎ GH deficiency ▪︎ Turner syndrome ▪︎ Noonan syndrome ▪︎ chronic renal failure before transplantation ▪︎ idiopathic short stature ▪︎ small-for-gestational-age short stature ▪︎ Prader-Willi syndrome ▪︎ SHOX gene abnormalit

⚡️Hemoglobin level is increase⬆️ in case of gastroenteritis due to dehydration If you found it decrease ⬇️ think about HUS

⚡️Early signs of hypoglycemia is : ▪︎blurred vision ▪︎shivering

⚡️#Arterial_blood_gasses (ABG) [part 2] 🔸️respiratory acidosis (type 2 respiratory failure) ▪︎airway problems [ COPD , near fatal asthma , ..] ▪︎Neuromuscular problems [Mysthenia gravis, guillain barre syndrome ,...] 🔸️Respiratory alkalosis (type 1 respiratory failure) شنو اسبابة ؟ ▪︎HYS ، Anxiety (rappid CO2 washout) ▪︎Alveoli problems [pneumonia, pulmonary embolism, pulmonary edema,..] ▪︎plural problems [pnemothorax, plural effusion ,...] ▪︎asthma (exception) 🔸️metabolic acidosis ▪︎DKA 🔸️Metabolic alkalosis ▪︎Gastric outlite obstruction as pyloric stenosis ▪︎ excessive use of diuretics

⚡️#Arterial_blood_gasses (ABG) [ مهم اوسكي ] ----------------- [Part 1] شلون نقرة تحليل ال ABG ؟ اول شي لازم نعرف ال normal levels مال PH ,PCO2 ,HCO3 🔸️Normal levels ▪︎ PH = 7.35 - 7.45 ▪︎ PCO2 = 35 - 45 mmHg ▪︎ HCO3 = 22 - 28 meq/L ------------------ طبعا احنة عدنا 4 شغلات ▪︎metabolic acidosis ▪︎metabolic alkalosis ▪︎respiratory acidosis ▪︎respiratory alkalosis شلون حنعرف شنو النوع المشكلة الي صايرة عندة المريض؟ نجي بالبداية نباوع على شغلتين ال PH و PCO2 ▪︎ اول شي نشوف ال PH اذا نازل (جوة ال 7.35) هذا acidosis واذا صاعد (فوك ال 7.45) هذا acidosis ▪︎نجي نباوع على ال PCO2 اذا شفناه متغير بنفس اتجاه تغير ال PH ( يعني ال PH وال PCO2 ثنينهن صاعدات او ثنينهن نازلات ) فهذا Metabolic اما اذا جان ال PCO2 متغير باتجاه معاكس لل PH ( يعني واحد صاعد والثاني نازل ) فهذا respiratory ▪︎ ⬇️PH , ⬇️ PCO2 = metabolic acidosis ▪︎ ⬆️PH , ⬆️PCO2 = metabolic alkalosis ▪︎ ⬇️PH , ⬆️PCO2 = respiratory acidosis ▪︎ ⬆️PH , ⬇️PCO2 = respiratory alkalosis 🔹️ زين هسة نريد نعرفة compensated لو noncompensated ؟ نجي نباوع على ال HCO3 اذا Normal معناها هذا noncompensated اذا متغير ( صاعد او نازل ) معناها هذا compensated 🔹️compensated also have 2 types : ( شوية تدوخ بس سهله ) ▪︎partially compensated هذا فقط ال HCO3 متغير ( صاعد او نازل ) وال PH بعدة abnormal( صاعد او نازل ) ▪︎completely compensated هذا مو بس ال HCO3 متغير ( صاعد او نازل ) وانما نلكي ال PH راجع لل normal ( قريب على ال 7.35 بحالة ال acidosis وقريب على 7.45 بحالة ال alkalosis ) Examples / ( ببساطة للتوضيح ) ▪︎ ⬇️PH , ⬇️ PCO2 ،⬆️ or ⬇️ HCO3 = partially compensated metabolic acidosis ▪︎ 🟢PH(7.43) , ⬆️PCO2 , ⬆️or⬇️ HCO3 = completely compensated metabolic alkalosis 🟢 = Normal 🔸️زين في حال ال PCO2 جان Normal ؟ ( مهم ) بهاي الحالة نباوع على ال PH وال HCO3 ونمشي على نفس القاعة السابقة (نفس الاتجاه Metabolic , عكس الاتجاه respiratory ) ▪︎ ⬇️PH , 🟢PCO2 , ⬇️HCO3 = metabolic acidosis ▪︎ ⬆️PH , 🟢PCO2 , ⬆️HCO3= metabolic alkalosis ▪︎ ⬇️PH , 🟢PCO2 , ⬆️HCO3= respiratory acidosis ▪︎ ⬆️PH , 🟢PCO2 , ⬇️PCO2= respiratory alkalosis 🟢 = Normal & ^^ There is more advanced details (if interesting read about it )

⚡️Abdominal examination is very important is case of DKA because some times appendicitis presented at the same time with DKA as trigger for DKA

⚡️5H of steriod (complications) ▪︎Hypertention ▪︎Hyperglycemia ▪︎Hypocalcemia ( decrease absorption of calcium from the intestine, and increase urinary calcium loss.) ▪︎Hyperlipidemia ▪︎Hirsutism 🔸️Growth suppression is one complication of steriod

⚡️down syndrome (د مناف) ▪︎cataract is one of complication occurs in patient witg down syndrome ▪︎bruish feild spot & single palmer creases in not Pathognomonic for down syndrome (can occour in normal population)

⚡️Stridor is triad of : ▪︎parking cough ▪︎hoarseness of voice ▪︎inspiratory noise

⚡️most common causes of acute stridor is COFFEE --------------- C : Croup O : Odema of larynx F : Foreign body F: inFection E : Epiglotitis E :Extra ( spasm ,retropharyngial abcess , laryngial compression)

⚡️first sign of chorea is change in hand writing

⚡️wieght is important in follow up of patient with meningitis لان ممكن يصير عندة SIADH syndrome ك complication لل meningitis ويبلش وزنه يزيد ! وهاي نفسها راح تسويلنا delusional hyponatreamia لذلك ضروري نتابع مستوى ال Na بالدم

⚡️methoprim is contraindicated in G6PD لذلك قبل مننطي مثبريم لازم نسال الطفل عندة داء الباكلة او تكسر بالدم !؟

⚡️ceftriaxone is not given rapped IV because it can cause arrhythmia ( so give in IV infusion)

⚡️child presented with fever and U don't found the focus of infection u should check 2 things: --------------------------- 1) GUE to exclude UTI (ابو ال UTI يلج بلبجية) 2) Examine the ear to exclude otitis media (hidden infection)

⚡️normal WBC in GUE ▪︎Male 2-3 ▪︎female 3-5