Dyslipidemia

Overweight and At Risk of Overweight: Quick Reference Overweight and At Risk of Overweight Whom To Draw: Weight ___________ BMI ___________ BP ___________     Height ___________ Height percentile __________ BMI percentile ___________ BP percentile ___________     If child > 2 y.o. and if parent has a Tchol >240mg/dL OR CV event before 55 y.o. Unknown FHx but cardiac risk factors are present BMI 85th percentile PCOS Dyslipidemia Risk Factors for T2DM: Race/ethnicity (non-Caucasian) FHx T2DM in 1st or 2nd degree relative Mother with GDM One of the following: HTN (≥ 95th %), acanthosis nigricans, dyslipidemia, PCOS Intervention If non-diabetic and ≥10 y.o.: LDL <110 mg/dL is ideal LDL 110-129 is borderline elevated LDL 130-159 mg/dL: Maximize non-pharmacological management LDL 160-189 mg/dL: Consider medication if more risk factors present LDL >190 mg/dL: Begin medication Isolated fasting triglycerides >400 mg/dL: Begin medication Labs: If BMI is 85th-94th percentile Without Risk Factors  Fasting lipid profile If BMI is 85th-94th percentile With 2 Risk Factors  Fasting lipid profile  ALT and AST  Fasting Glucose If BMI is ≥95th percentile and ≥ 10 y.o.  Fasting lipid profile  ALT and AST  Fasting glucose  Other tests as indicated by health risks NOTE: A 2-hr glucose challenge (OGTT) is more sensitive than a fasting glucose for diagnosing pre-diabetes. Intervention: Readiness to Change Assessment Motivational Interviewing Dialogue Key Messages Medical work-up and intervention as appropriate When your patient leaves the room feeling smart and empowered , You know you have Facilitated Change! Motivational Interviewing Dialogue Step 1:Brief Structuring Statement  “Can we take a few minutes to discuss your weight and health?  “How do you feel about your weight and health?”  “If you had a magic wand and you could change anything you wanted about your body what would you change?” Step 3: Affirm  “ I appreciate how hard it must be for you to talk about this topic”  “ If I were in your position, I would also find this situation difficult” Step 2 : Reflective Listening & Listening for Change Talk  “It sounds like you…”  “You’re feeling…”  “It seems that you…”  “So you…” Step 4: Action Planning  Offer a brief summary  Share information about BMI% & Key Messages  Provide brief, focused advice Hypertension Work Up 1 1 The Fourth Report on the Diagnosis, Evaluation, and Treatment of High Blood Pressure in Children and Adolescents: Pediatrics Vol. 114 No. 2 August 2004, pp. 555-576 Pre-Hypertension Definition Evaluation BPs on 3 different occasions systolic OR diastolic UA / UC BUN/CR, lytes CBC Renal ultrasound ECHO cardiogram Retinal exam (referral) Further imaging and labs ≥90th % - <95th% Stage 1 HTN 95th % - 5mm Hg above 99th% X X X X X X Stage 2 HTN > 5mm Hg above 99th % X X X X X X Refer to Peds renal w/in 2 wks. Immediately, if symptomatic X X X X X Always Weight loss, if indicated Lifestyle Modifications Exercise, 30-60 mins/d Decrease sedentary activities DASH diet Tobacco cessation (Refer as needed) X X X X X Compelling complications, only X X X www.nhlbi.nih.gov/health/public/heart/hbp/dash/new_dash.pdf Medications, IF… Follow- up In 6 months X · End organ damage · HTN is secondary · Symptomatic · Diabetes, type 1 or 2 · Persistent despite 6 mo of lifestyle modification Regularly Frequently until stabilized Polycystic Ovary Syndrome (PCOS) Definition: Persistent anovulation Lab or clinical evidence of hyperandrogenism Evaluation 1) TSH, Prolactin, Pregnancy test 2) Lipid profile, fasting 3) If amenorrheic: Provera challenge (10 mg provera qd x 10d) 4) +/- Total testosterone +/- DHEA-S +/- 17-OH progesterone, 8am and fasting 5) If sxs of Cushing’s: dexamethasone suppression test 6) If obesity/acanthosis: fasting and/or 2 hr glucose as in obesity protocol Treatment: Weight loss, if indicated Estrogen/progesterone combo (OCP, patch, ring) Consider metformin Refer for severe or recalcitrant hirsutism History: Menses FHx of PCOS Premature adrenarche Rapidity of onset of androgenic changes Hirsutism – any depilatory measures Physical Exam: Hirsutism Acne Clitoromegaly Virilization Premature adrenarche if pre-menarchal