STEP 2 CS CHILD WITH DM? how to take child history .?

CHILD WITH DM?
 
T-DIABETES MISS H-MELLITUS

T-Type ?
D-Description of 1st ep(polyuria,phagia,dipsia?)
I-Irritability
A-Abnormal thirst,urination at present time
B-Birth hx
E-Eating habits
T-Tiredness(fatigue)
E-Emotion of parents/child about the disease
S-Sugar level(last sugar?ranges?)
M-Meds? meds compliants?
I-injector insulin (who does?)
S-Site of injection
S-Schedule for insulin
H-Hypoglycemic episode(Dizzy,confuse ,sweat,palpitation_)
M-Mood
L-LMP
L-LOS
I-Itchy/skin Infection
T-Tingling/numbness/weakness
U-urinary habits
S-super child (weight gain/loss)

（ROS)review of system for pediatric -
FEVER CUD SAD

Fever

Ear discharge/pulling

Vomit(onset,color,frequency)

Eyes discharge

Rash
 Rhinorrhea

Cry
chest symptoms 
cold(recent URI,ruuny nose/ cough/chest pain,SOB,difficulty swallowing)

Urination(increase of decrease,diapers,odor,color,dysuria)

Diarrhea(onset,frequency,color,blood,mucus)

Sleep 
Seizure (Loss of bowel/urine, loss of consciousness)

Activity(awake,playful,how does it looks?)

Dehydration (dry mouth,shrunken eyes,soft or shrunken spots over the head 'fontanelss")

Pediatric (PMH) past medical history

PAM IF BIG DEALS

PMH -childhood illness and infection? has ur child had any serious illness or infection?does the child have dm,asthma,seizure?
Allergy- does ur child have any allergies?
Medication- is ur child taking any medication

I'll contact

Family history- does anyone in ur family have a similar 
problem/other medical problem?

Birth history

-was ur pregnancy full term(40weeks or 9months?)

- did u have routine checkup during pregnancy?how often?

-did u have any complications during ur pregnancy/during ur delivery/after delivery?

-was an ultrasound performed during your pregnancy?

- did u smoke,drink or use drugs during pregnancy?

- was it a vaginal delivery or C-section?

-did ur child have any medical problems after birth?

-when did ur child have her/his first bowel movement? 

Imunization - are ur child immunization utd?

Growth development
- is ur child develepment on track for their given age?

- when did ur child first smile?first sit up? first crawling?start talking?start walking? learn to dress himself?start using short sentense? 

Day care- accommodation / main carer / who lives with child?/any sick contact?

Eating habits - did u notice any changes of ur child's eating habits?

Appetite- how is ur child appetite?

Last check up - when was the date of your child's last routine checkup?was it normal?

DIAGNOSTIC WORKUP for Child with Diabetes mnemonic

• Basic metabolic panel
• HbA1c
• Urinalysis/Microalbuminuria
• Insulin and C-peptide level
• Islet cell antibodies
• 24 hour urine cortisol

DIFFERENTIAL DIAGNOSIS: 

• Type 1 Diabetes Mellitus
• Type 2 Diabetes Mellitus
• Cushing’s syndrome

HISTORY

HPI:the source of information is the patient’s mother. The mother of 10 yo F states that her chils was diagnosed with DM 1 month ago,when she presented with excessive thirst and frequent urination. The parents were shocked after the diagnosis was made. The child seems concerned but not irritable or depressed. She is active ,play tennis and is currently on a diet prescribed by a dietitian. She is on insulin injections and regularly monitors her blood glucose levels at home. Her compliance is good ;she checks her blood glucose before each meals and at bed time. Fasting glucose level are usually 80 to the low 100s and in the high 100s before meals. She has not had any episode of hypoglyemica.she has lost 9ibs in the past 3mo,but her weight is stable now at about 180ibs. She denies any weakness, fatigue, tingling over limbs,visual symptoms or rash/itch at the injection sites. She has not yet started menstruating.

ROS: neagative.

ALLERGIES: NKDA

MEDICATION: insulin

PMH:none.

PSH: none.

BIRTH HISTORY:normal.

DEVELOPMENTAL HISTORY: normal.

FH:no family history of diabetes.

PHYSICAL EXAMINATION: NONE

DIFFERENTIAL DIAGNOSIS

DIAGNOSIS 1 TYPE 1 DIABETES MELLITUS

-polyuria,polydipsia

-recent weigh loss

-hyperglycemia

DIAGNOSIS 2 TYPE 2 DIABETES MELLITUS

-polyuria,polydipsia

-obesity

-hyperglycemia

DIAGNOSIS 3 CUSHING SYNDROME

-obesity

DIAGNOSTIC WORKUP:

-insulin and c-peptide level

-islet cell antibodies

-HbA1c

- electrolytes,glucose

-UA and urine microalbumin

-24 hour urine free cortisol