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Okay, so a lot of guys who were getting there, it's one more. We talk here before another coffee brush on board. You know, we have time. So I'm gonna do a quick presentation on pediatric the cane. I know we've already had on killing your inner ear specialists and diabetes and all this morning, so I'm nowhere labor. That's too much. But I just want to highlight some of the differences with a pediatric DKA has proved adult. Okay, The first thing, just it. And what is that? A pediatric. Okay, Has a calorie it off 0.3% with little seems quite small number. Actually, that's quite high on Do see a fair period of DKA. We'll probably see you in a week or so You want me. And on the mortality there, between 60 and 90% mortality is to desirable eczema and so really important that we mind on DKA appropriately and according to the guidance, and try and prevent those deaths. So the first thing is just on, uh, diagnosing DKA eso you want to satisfy both by a chemical on cloud with criteria. So for the biochemical criteria you're looking for hyperglycemia be above above 11 acidosis, which is a ph of less than 7.3 your bicarb of last and 15. And he took us, which is our keto, and imagine them above three kind of criteria are they should be dehydrated. Um, bombing, drowsy or clinically asking about acidotic. Okay, Don't have all those criteria that they should have at least some of them in terms of an assassin. The Samaritans. Okay, we talked about a percentage dehydration. Okay, so we've got miles and laughed in the yellow, and that's gonna be a ph of just last 7.37 point two on the thoughts for the pH is then, um, estimate there dehydration to be a 0.5% on less than 7.2, then is in the water in the middle, about 7.1, and that's gonna be 7% the hydration on. But you should be your daycare then would accept with pH of last 7.1 on that would correspond to about 10% dehydration. So, in terms of assessing the child Ramadhan ABCDE approach a rape, reeling, circulation, disability exposure, important distance in here that we need thio and explained the moment out he ever present on what's going on and reassure them that we know what we're doing. Um, on. But but but but the main priority office think it is to treat child from here on, these kids will be will be scared. Still be a friends will be feeling rotten and miserable. That's really important that we, um, talked to them as well. So important that we get we get an accurate we get dessert is possible to be surprised taking the kids that come in here really sick and often they're able to stand up, but least to get Yeah, I like it. We get this worth doing that just that we can send it directly. So in terms of assassin, them were looking for signs of shock and not like that's getting and we'll look for a prone to copy fulltime a tachycardia. Hypertension. Um, I'm gonna get the child. I will treat that shock with and 10 million doses off normal ceiling on. The idea really is here that you're gonna keep get the time appreciative of us and then reassess after each one on these balls that should be given by Syringe and Teo. Um Uh, okay, These kids can't. Must be hard to get candles. And two, because if you miss your shot and dry, so don't worry if you can get the blood so often, actually on, go ahead and stay there, making it to you and then off in capsules on day once you once you get in the research station for it, go up to a max of 40. But, you know, once you're up for it pretty low, then you only get, um, intensive care of old. Okay, I'm going to think about and troops. But while you're waiting for the intensive care of you to come on financial to get started, we will keep going up to an absolute max of 60 miles per kilo. Yeah. Then we've got some calculations to do. Okay. On the right side of pediatric endocrinology of diabetes have a fabulous online couple, it er, which you can use to help with confirmations. But our guidance are guidelines are also in hard copy on their own and then turn it on. And it's just really important. That apparently was often having him again on diet. Normally do both, so that you're tracking the to calculations okay, on ideally, should have two different people do the calculation separately. I'm making sure that they're coming together with semen, sir. Really important that we didn't get the monster. Okay, so ultimately, they and the calculation is that you want the work high Hyping the deficit is we were going by take besides dehydration to say your pH is 6.9, they're gonna be 10% dehydrated. She'll take the preventative headache, which is 10 times that, by the way, it in kilos and then we'll play by 10. Cannot give you that setting mills we embolize thio and take away the poor ball is fluid. That was given on an odd on the maintenance on his maintenance that they were requiring next 48 ours okay. And so you were quite how much mean? It's supposedly for 40 hours, and then you add on and the total of the deficit mine is the bullets, and that gives you the tools Hopefully that the child needs and on exporting at ours when we give them as an infusion over 40 at ours on a continuous infusion on the reason we do that is that we're wanting and Children where you're really careful, we won't have a still resolution of the year. We don't want them to be out of decay and three hours time we want them to take the 40 hours to really resolved. Okay, and then, which is definitely a big Africa. We have a one or delay so we don't give insulin for a least in our after the fluid starters. And the reason for that is that it's been showing that given insulin early and pediatrics increases your risk of terrible edema, which is the big thing we want to avoid, Um, so, um, important the week about that lease and are delay before we start insulin infusion. And I was kid, hey, help really this morning with the adults. If the child comes with an insulin pump, attacks that we need to turn that off on if they're on a beers. Olds are a little backed insulin. Then what's really important that we keep on going? And so I just said, I already get the get the lanes and full of them on doing what kind of memory? Get the game and so you go through them. One thing I would say there was. Make sure that we're not doing that front of parents because there's nothing less on downstairs last confidence than and two doctors standing. And that's got in their ads about this big pump love notes trying to work out what to do with the child. And so, yes, get the guidelines. Okay, but maybe 10 minutes is a next door or away from the clinical area. Um, coverage through the mixture, right and mean thing, as as cased covered this morning, is that we need to keep my enough potassium and possibly drop as we get food. So keep an antacid now potassium into the and placement foods and keep it. Once you're insulin on brakes, you're getting fluid. Calculations. Correct. And so this is about informing your seniors. Okay, so it's important that you're asking me and these gets up. And if I'm like, it's all one called, um, it's three in the morning and you got a chicken on my Ph of seven. Then I want to know about to give me a form. Um, ask that to your seniors on pediatric change potency, and I'm getting that. She's evolved early. It's the red flag to look out for me early, and it's kind of start with the month on because we haven't really started. That's occurrence for twin 60 90% of your mortality and DKA pediatrics. So and if you get me the signs of Sandra Day, which really is had a worsening headaches were just conscious level vomiting and or laughter. J be on more drowsy, and they will eventually turn it into a coma. So what we need to do your first of all is exclude that they're no hypoglycemic. So make sure the m hasn't dropped so far that they're no hypoglycemic. And if you know hypoglycemic, that's important that we go ahead and give them my hypertonic ceiling. Um, that's three meals per kilo of 3.7% and normal ceiling. Sorry to 0.77, and we adjust the IV foods and we're going over just delayed by half. So if they're normally on 100 miles per hour, we're just up to 50. And we're gonna ask that I see you because these kids often will deteriorate into you feel cold. Answer. Start Just the CS and coma will require to be intubated on by Marcy. I'm not sure be a senior senior conditioned imagination, and once that's all sort of them a challenge and gassy tea. Just have a look for other. And for several events which may have caused the symptoms, the mother said. When they tended to think about pediatric, that's a pair transpire. So just for take a home points for this one. Then I realized I just try to focus on the amendments that met Teo. The margin of DKA for pediatrics. So Assassin Tyler, front of you on Get accurate. We earlier on cold for your seniors or laying not sports nursing on men ago and concentrate your bolus fluids first on. Treat the shock on on, then do your calculations carefully. Uh, these kids need really soaks wandering on once the treatments commenced on that messing toe, the pediatric Okay, so that's quite run through and open ended questions that everyone is getting the other questions. So question is a country available for our fluids on up, And so I think the emergency pick you up does have own. But, um, it's probably bastard. You need to use a BSP website, but you can get on your phone on get quite helpful unless you print off a pdf of the population, which you command stating child's name on to it. But then it hurts on AMA was raised around my question. Do you have any text? You know, like the adolescents 16, 7 times when we come here, you know, so sorry. Oh, sure, you know, I know, and I'll type before and, you know, unless it's a simple in the 2016 17 year olds, any tips for their plates? Find the pediatric one was given after. Now, let's get to much and everybody gets those who do. You think that was just asking about the adolescent patients who 16 17 year olds We kind of fall in between on my face like, Well, give me one of fluid on start on. So the the evidence probably is the VSP. The guys are have been pushing for a number of years that the best guidance the pediatric group called the extended up to the 25 year olds because that's the age group, really, that we're sure concerned about several of the man so we don't want rapidly correct okay and news and the appetite five year olds and But there's this kind of cultural, especially from Accredo care perspective off. Well, they're 17 or they're 24. Just tried before them to them and try and get him better. And but we probably just need to from 80. Perfect need to be asked That makes these patients for layer up in senior folk. And don't be and be Russian with lots of lots of food for them because they are Aresco Several Good, good. Answer your question on for just five. I'll say, Is there a cream in here is of these 16 17 year olds will be emitted. Teo battled wart under medicine, but the pediatric team will assess within eyes. Mint off the protocol because they are still mine is on the pediatric protocol up to the team. So and your men, these kids, they start 16 17. Then you referred. Opposed Pete's on medicine, but they got admitted under medicines, medicine to the clerk and peaceful and managed to take a right. So I think that seems to be it with more and questions to It's coffee time Children involved days to If you take 15 minutes from know about for 10 past on get started on the next section. No, all right,