(NR 328 WK 5) Chapter 31: The Child with Endocrine Dysfunction with PP slides
Drug of choice for Diabetes inspidus (Di) given either via nasal spray, IM or sub q. treatment is for LIFE
DDAVP
•EXCRETION OF LARGE AMOUNTS OF DILUTED URINE •THE PRINCIPAL DISORDER OF THE POSTERIOR PITUITARY •RESULTS FROM HYPOSECRETION OF ADH •PRODUCES UNCONTROLLED DIURESIS •PRIMARY CAUSES—FAMILIAL OR IDIOPATHIC •SECONDARY CAUSES—TRAUMA, TUMORS, CNS INFECTION, ANEURYSM -Daily hormone replacement of VASOPRESSIN Cardinal Sign * Polyuria AND Polydipsia FIRST sign* Enuresis
Diabetes Insipidus
Hypothyroidism can occur with a patient that has HYPERTHYROIDISM caused by over dosage so teach patients / parents to watch out for S/S of hypo. FYI
FYI
Medication for Precocious puberty is a synthetic form of ? and is discontinued at age for NORMAL pubertal changes to resume.
Leutinizing hormone
Long term complications of uncontrolled diabetes are?
Retinopathy, neuropathy and vascular complications
Hypothyroidism Lab findings? TSH - T4-
TSH increased (>4.0) T4 decreased
MEDICATION THERAPY - GOAL IS TO DECREASE SECRETION OF THYROID HORMONE; PROPYLTHIOURACIL (PTU) OR METHIMAZOLE (MTZ, TAPAZOLE) - utilized TID and may take 6-12 weeks for therapeutic effects - severe leukopenia may occur patient may report: Other meds used: Propanolol may be used after thyrotoxicosis or thyroid storm to reduce sign and symptom. Radioiodine 131 - but not usually recommended for children.
sore throat, lymph node enlargement, fever and skin rashes.
A goiter is an enlargement or hypertrophy of which gland? a. Thyroid b. Adrenal c. Anterior pituitary d. Posterior pituitary
A (A goiter is an enlargement or hypertrophy of the thyroid gland. Goiter is not associated with the adrenal, anterior pituitary, or posterior pituitary secretory organs.)
What nursing care should be included for a child diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH)? a. Maintain the child NPO (nothing by mouth). b. Turn the child frequently. c. Restrict fluids. d. Encourage fluids.
ANS: C Increased secretion of ADH causes the kidney to reabsorb water, which increases fluid volume and decreases serum osmolarity with a progressive reduction in sodium concentration. The immediate management of the child is to restrict fluids but not food. Frequently turning the child is not necessary unless the child is unresponsive. Encouraging fluids will worsen the child's condition.
A child will start treatment for central precocious puberty. What synthetic hormone will be injected? a. Thyrotropin b. Gonadotropins c. Somatotropic hormone d. Luteinizing hormone-releasing hormone
ANS: D Precocious puberty of central origin is treated with monthly subcutaneous injections of luteinizing hormone-releasing hormone, which regulates pituitary secretions. Thyrotropin, gonadotropins, and somatotropic hormone are not the appropriate therapies for precocious puberty.
Pituitary hyperfunction: FYI Therapeutic management varies include but not limited to: 1. Surgical treatment to remove tumor 2. Radiation and radioactive implants 3. Hormone replacement therapy 4. Meds to shrink tumor and normalize pituitary hormone productions.
FYI
•PERFORMED TO IDENTIFY IF HGH (HUMAN GROWTH HORMONE) IS DEFICIENT. THE TEST IS PERFORMED BY ADMINISTERING THE AMINO ACID ARGININE IN A VEIN TO RAISE HGH LEVELS. FOR Patients diagnosed with a short stature. MEDICATIONS: - BOYS= testosterone injections -GIRLS= PO etinyl estradiol with combination of medroxyprogesterone.
Growth hormone stimulation test
Pituitary Gland AKA______ is called the "master gland" because it regulates the other glands. Two portions: Adenohypophysis (anterior) secretes; GH, TSH, ACTH, Follicle-stimulating hormone (FSH), Luteinizing hormone LH, and PROLACTIN. Neurohypophysis (posterior) secretes: ADH and Oxytocin and are regulated by hormones secreted from the HYPOTHALAMUS.
Hypophysis
Diminished secretion of one of more pituitary hormones - consequences are dependent on the dysfunction: Gonadotropin deficiency -low LH or FSH ( absence or regression of secondary characteristics). GH deficiency - stunted somatic growth TSH deficiency- produces hypothyroidism Corticotropin deficiency- results in manifestations of adrenal hypofunction
Hypopituitarism
Diabetic ketosis: 1. Ketones and glucose in urine. 2. Dehydration in some cases. Diabetic Ketoacidosis: 1. Dehydration, electrolyte imbalance, acidosis and ____
Kussmaul respirations
•METABOLIC DISORDER THAT AFFECTS BODY'S PROTEIN UTILIZATION CAUSED BY A DEFECT IN THE ENZYME THAT BREAKS DOWN THE AMINO ACID PHENYLALANINE. - Deficiency in Liver enzyme -Decreased tyrosine causes a deficiency of the pigment melanin, causing most patients to have blond hair, blue eyes, fair skin and prone to eczema. ( SO WEAR SUN BLOCK or hats etc). Lab: PHE >4 mg/dl (considered high) Manifestations: Seizures Growth/behavioral problems musty breath odor Failure to thrive intellectual disability Meds: Anti-epileptic for seizures and modified protein
PKU ( Phenylketonuria)
Being greater than 2 standard deviations below the mean. GIRLS: NO breasts by 13, NO pubic hair by 14, or NO period after 4 years of onset of breasts- usually by 16. BOYS: NO testicular enlargement by 13 NO pubic hair by 15, incomplete genital growth 4-5 years after testicular enlargement. -Precocious puberty which is an early onset of puberty occurring before 8-9 years old can also result in this - as an adult. **May require referral to Endocrinologist ***
Short Stature
Synthroid or levothroid best TH replacement therapy to eliminate S/S of hypothyroidism and drug therapy is required FOR LIFE. Educate families on importance of follow up lab assessment for ?
T4 ( to ensure appropriate dosage)
Graves disease and Thyroid storm (Thyrotoxicosis) are complication types of HYPERTHYROIDISM Lab findings are ? TSH- T4 and T3-
TSH decreased T4 and T3 increased (tSH screening is a route state mandate given to newborns prior to discharge)
Pituitary Hyperfunction: Reach heights of 8 feet or more weight is generally in proportion to height. -Can be idiopathic or tumor Excess GH after epiphyseal closure is called?
acromegaly
In caring for a patient with SiADH manifestations are anorexia, nausea/vomiting and irritability and personality changes. These symptoms will disappear when which hormone has decreased?
ADH
THE NURSE CARING FOR A 14-YEAR-OLD GIRL WITH DIABETES INSIPIDUS (DI) UNDERSTANDS WHICH OF THE FOLLOWING ABOUT THIS DISORDER? A •DI IS TREATED ON A SHORT-TERM BASIS WITH HORMONE REPLACEMENT THERAPY B •DI MAY CAUSE ANOREXIA IF PROPER MEAL PLANNING IS NOT ADDRESSED C •DI IS TREATED WITH VASOPRESSIN ON A LIFELONG BASIS D •DI REQUIRES STRICT FLUID LIMITATION UNTIL IT RESOLVES
C (the tx of choice - Di is a lifelong disease)
Patients with growth hormone deficiency injections are given when for best results?
bedtime ( treatments are very expensive!)
The thyroid-stimulating hormone (TSH) increases secretion in response to which hormone? a. Low levels of circulating thyroid hormone b. High levels of circulating thyroid hormone c. Low levels of circulating adrenocorticotropic hormone d. High levels of circulating adrenocorticotropic hormone
A (As blood concentrations of the target hormones reach normal levels, a negative message is sent to the anterior pituitary to inhibit release of the tropic hormone. For example, TSH responds to low levels of circulating TH. As blood levels of TH reach normal concentrations, a negative feedback message is sent to the anterior pituitary, resulting in diminished release of TSH. Adrenocorticotropic stimulates the adrenals to secrete glucocorticoids).
The nurse is assisting with a growth hormone stimulation test for a child with short stature. What should the nurse monitor closely on this child during the test? a. Hypotension b. Tachycardia c. Hypoglycemia d. Nausea and vomiting
A (Patients receiving clonidine (Catapres) for a growth hormone stimulation test require close blood pressure monitoring for hypotension. Tachycardia, hypoglycemia, and nausea and vomiting do not occur with Catapres administered for a growth hormone stimulation test.)
What form of diabetes is characterized by destruction of pancreatic beta cells, resulting in insulin deficiency? a. Type 1 diabetes b. Type 2 diabetes c. Gestational diabetes d. Maturity-onset diabetes of the young (MODY)
A (Type 1 diabetes is characterized by the destruction of the pancreatic beta cells, which leads to absolute insulin deficiency. Type 2 diabetes results usually from insulin resistance. The pancreatic beta cells are not destroyed in gestational diabetes. MODY is an autosomal dominant monogenetic defect in beta cell function that is characterized by impaired insulin secretion with minimum or no defects in insulin action.)
A child with growth hormone (GH) deficiency is receiving GH therapy. When is the best time for the GH to be administered? a. At bedtime b. After meals c. Before meals d. After arising in morning
A Injections are best given at bedtime to more closely approximate the physiologic release of GH. After meals, before meals, and after arising in the morning do not parallel the physiologic release of the hormone.
The nurse is planning care for a child recently diagnosed with diabetes insipidus (DI). What intervention should be included? a. Encourage the child to wear medical identification. b. Discuss with the child and family ways to limit fluid intake. c. Teach the child and family how to do required urine testing. d. Reassure the child and family that this is usually not a chronic or life-threatening illness.
ANS: A DI is a potentially life-threatening disorder if the voluntary demand for fluid is suppressed or the child does not have access to fluids. Medical alert identification should be worn. Fluid intake is not restricted in children with DI. The child is unable to concentrate urine and can rapidly become dehydrated. Fluid intake may be limited during diagnosis, when the lack of intake will result in decreased urinary output and dehydration. Urine testing is not required in DI. Changes in body weight provide information about approximate fluid balance. This is a lifelong disorder that requires supplemental vasopressin throughout life
Chronic adrenocortical insufficiency is also referred to as: a. Graves disease. b. Addison disease. c. Cushing syndrome. d. Hashimoto disease.
ANS: B Addison disease is chronic adrenocortical insufficiency.
Intranasal administration of desmopressin acetate (DDAVP) is used to treat which condition? a. Hypopituitarism b. Diabetes insipidus (DI) c. Syndrome of inappropriate antidiuretic hormone (SIADH) d. Acute adrenocortical insufficiency
ANS: B DDAVP is the treatment of choice for DI. It is administered intranasally through a flexible tube. The child's response pattern is variable, with effectiveness lasting from 6 to 24 hours
The nurse is caring for a child with suspected diabetes insipidus. Which of the following clinical manifestations would the nurse expect to observe? a. Oliguria b. Glycosuria c. Nausea and vomiting d. Polyuria and polydipsia
ANS: D Excessive urination accompanied by insatiable thirst is the primary clinical manifestation of diabetes. These symptoms may be so severe that the child does little other than drink and urinate.
The nurse is preparing to administer a prescribed dose of desmopressin acetate (DDAVP) intramuscularly (IM) to a child with diabetes insipidus. What action should the nurse take before drawing the medication into a syringe? a. Mix the medication with sterile water. b. Mix the medication with sterile normal saline. c. Have another nurse double-check the medication dose. d. Hold the medication under warm water for 10 to 15 minutes and then shake vigorously.
ANS: D To be effective, vasopressin must be thoroughly mixed in the oil by being held under warm running water for 10 to 15 minutes and shaken vigorously before being drawn into the syringe. If this is not done, the oil may be injected minus the antidiuretic hormone. Small brown particles, which indicate drug dispersion, must be seen in the suspension
A child with hypopituitarism is being started on growth hormone (GH) therapy. Nursing considerations should be based on which knowledge? a. Therapy is most successful if it is started during adolescence. b. Replacement therapy requires daily subcutaneous injections. c. Hormonal supplementation will be required throughout child's lifetime. d. Treatment is considered successful if children attain full stature by adolescence.
B (Additional support is required for children who require hormone replacement therapy, such as preparation for daily subcutaneous injections and education for self-management during the school-age years. Young children, obese children, and those who are severely GH deficient have the best response to therapy. Replacement therapy is not needed after attaining final height. The children are no longer GH deficient. When therapy is successful, children can attain their actual or near-final adult height at a slower rate than their peers.)
The nurse is caring for a child after a parathyroidectomy. What medication should the nurse have available if hypocalcemia occurs? a. Insulin b. Calcium gluconate c. Propylthiouracil (PTU) d. Cortisone (hydrocortisone)
B (Because hypocalcemia is a potential complication after a parathyroidectomy, observing for signs of tetany, instituting seizure precautions, and having calcium gluconate available for emergency use are part of the nursing care)
Peripheral precocious puberty (PPP) differs from central precocious puberty (CPP) in which manner? a. PPP results from a central nervous system (CNS) insult. b. PPP occurs more frequently in girls. c. PPP may be viewed as a variation in sexual development. d. PPP results from hormonal stimulation of the hypothalamic gonadotropin-releasing hormone (Gn-RH).
C PPP may be viewed as a variation in sexual development. PPP results from hormone stimulation other than the hypothalamic Gn-RH. Isolated manifestations of secondary sexual development occur. PPP can be missed if these changes are viewed as variations in pubertal onset. CPP results from CNS insult, occurs more frequently in girls, and results from hormonal stimulation of the hypothalamic Gn-RH
A preadolescent has maintained good glycemic control of his type 1 diabetes through the school year. During summer vacation, he has had repeated episodes of hypoglycemia. What additional teaching is needed? a. Carbohydrates in the diet need to be replaced with protein. b. Additional snacks are needed to compensate for increased activity. c. The child needs to decrease his activity level to minimize episodes of hypoglycemia. d. Insulin dosage should be increased to compensate for a change in activity level.
B (Most children have a different schedule during summer vacation. The increased activity and exercise reduce insulin resistance and increase glucose utilization. Additional snacks should be eaten before physical activity to increase carbohydrates and protein and compensate for increased activity. Physical activity should always be encouraged if the child is capable. The benefits include improved glucose utilization and decreased insulin requirements. In consultation with the practitioner, insulin dosage may need to be decreased because of improved glucose utilization.)
The nurse is caring for an 11-year-old boy who has recently been diagnosed with diabetes. Which of the following should be included in the teaching plan for daily injections? a. The parents do not need to learn the procedure. b. He is old enough to give most of his own injections. c. Self-injections will be possible when he is closer to adolescence. d. He can learn about self-injections when he is able to reach all injection sites.
B (School-age children are able to give their own injections.)
The school nurse practitioner is consulted by a fifth-grade teacher about a student who has become increasingly inattentive and hyperactive in the classroom. The nurse notes that the child's weight has changed from the 50th percentile to the 30th percentile. The nurse is concerned about possible hyperthyroidism. What additional sign or symptom should the nurse anticipate? a. Skin that is cool and dry b. Blurred vision and loss of acuity c. Running and being active during recess d. Decreased appetite and food intake
B (Visual disturbances such as loss of visual acuity and blurred vision are associated with hyperthyroidism. They may occur before the actual onset of other symptoms. The child's skin is usually warm, flushed, and moist. Although the signs of hyperthyroidism include excessive motion, irritability, hyperactivity, short attention span, and emotional lability, these children are easily fatigued and require frequent rest periods. Children with hyperthyroidism have increased food intake. Even with voracious appetites, weight loss occurs)
A parent asks the nurse why self-monitoring of blood glucose is being recommended for her child with diabetes. The nurse should base the explanation on which of the following? a. It is a less expensive method of testing. b. It is not as accurate as laboratory testing. c. Children are better able to manage the diabetes. d. The parents are better able to manage the disease.
C (Blood glucose self-management has improved diabetes management and can be used successfully by children from the time of diagnosis. Insulin dosages can be adjusted based on blood glucose results.)
A child is receiving propylthiouracil for the treatment of hyperthyroidism (Graves disease). The parents and child should be taught to recognize and report which sign or symptom immediately? a. Fatigue b. Weight loss c. Fever, sore throat d. Upper respiratory tract infection
C (Children being treated with propylthiouracil must be carefully monitored for the side effects of the drug. Parents must be alerted that sore throat and fever accompany the grave complication of leukopenia. These symptoms should be immediately reported. Fatigue and weight loss are manifestations of hyperthyroidism. Their presence may indicate that the drug is not effective but does not require immediate evaluation. Upper respiratory tract infections are most likely viral in origin and not a sign of leukopenia.)
What is a common clinical manifestation of juvenile hypothyroidism? a. Insomnia b. Diarrhea c. Dry skin d. Rapid growth
C (Dry skin, mental decline, and myxedematous skin changes are associated with juvenile hypothyroidism. Children with hypothyroidism often have sleepiness, constipation, and decelerated growth.)
The parents of a child who has just been diagnosed with type 1 diabetes ask about exercise. What effect does exercise have on a type 1 diabetic? a. Exercise increases blood glucose. b. Extra insulin is required during exercise. c. Additional snacks are needed before exercise. d. Excessive physical activity should be restricted.
C (Exercise lowers blood glucose levels, decreasing the need for insulin. Extra snacks are provided to maintain the blood glucose levels. Exercise is encouraged and not restricted unless indicated by other health conditions.)
Which of the following statements best describes hypopituitarism? a. Growth is normal during the first 3 years of life. b. Weight is usually more retarded than height. c. Skeletal proportions are normal for age. d. Most of these children have subnormal intelligence.
C (In children with hypopituitarism, the skeletal proportions are normal.)
At what age is sexual development in boys and girls considered to be precocious? a. Boys, 11 years; girls, 9 years b. Boys, 12 years; girls, 10 years c. Boys, 9 years; girls, 8 years d. Boys, 10 years; girls, 9-1/2 years
C (Manifestations of sexual development before age 9 in boys and age 8 in girls is considered precocious and should be investigated.)
Which of the following is characteristic of the immune-mediated type 1 diabetes mellitus? a. Ketoacidosis is infrequent. b. Onset is gradual. c. Age at onset is usually younger than 20 years. d. Oral agents are often effective for treatment.
C (The immune-mediated type 1 diabetes mellitus typically has its onset in children or young adults.)
An adolescent diabetic is admitted to the emergency department for treatment of hyperglycemia and pneumonia. What are characteristics of diabetic hyperglycemia? a. Cold, clammy skin and lethargy b. Hunger and hypertension c. Thirst, being flushed, and fruity breath d. Disorientation and pallor
C (The signs of hyperglycemia are thirst, being flushed, and fruity breath. The skin is not cold or clammy, and there is not hunger and hypertension. Disorientation and pallor are signs of hypoglycemia.)
A rare neurodegenerative condition reported in some patients after recving human GH from a cadaver -Does NOT occur with biosynthetic GH -Occurs spontaneously, inherited or transmitted by contact with infected tissue from transplant or eating contaminated meat - causes dimentia and death NO CURE.
CJD ( Creutzfeldt-Jacob Disease)
The nurse is taking care of a child who had a thyroidectomy. The nurse recognizes what as a positive Chvostek sign? a. Paresthesia occurring in feet and toes b. Frequent sharp flexion of wrist and ankle joints c. Carpal spasm elicited by pressure applied to the nerves of the upper arm d. Facial muscle spasm elicited by tapping the facial nerve in the region of the parotid gland
D (A positive Chvostek sign is a facial muscle spasm that is elicited by tapping the facial nerve in the region of the parotid gland. Paresthesia occurring in the feet and toes and frequent sharp flexion of the wrist and ankle joints can be signs of hypoparathyroidism but are not part of a positive Chvostek sign. Carpal spasm elicited by pressure applied to nerves of the upper arm is called a positive Trousseau sign.)
The nurse is teaching an adolescent about giving insulin injections. The adolescent asks if the disposable needles and syringes can be used more than once. The nurse's response should be based on which knowledge? a. It is unsafe. b. It is acceptable for up to 24 hours. c. It is acceptable for families with very limited resources. d. It is suitable for up to 3 days if stored in the refrigerator.
D (Bacterial counts are unaffected if insulin syringes are handled in an aseptic manner and stored in the refrigerator between use. The syringes can be used up to 3 days and result in a considerable cost savings. Bacterial counts remain low for up to 72 hours with proper technique. The family's resources are not an issue; if a practice is unsafe, the family should not be encouraged to endanger the child by reusing equipment.)
What blood glucose measurement is most likely associated with diabetic ketoacidosis? a. 185 mg/dl b. 220 mg/dl c. 280 mg/dl d. 330 mg/dl
D (Diabetic ketoacidosis is a state of relative insulin insufficiency and may include the presence of hyperglycemia, a blood glucose level greater than or equal to 330 mg/dl; 185, 220, and 280 mg/dl are values that are too low for the definition of ketoacidosis.)
The clinic nurse is assessing a child with hypopituitarism. Hypopituitarism can lead to which disorder? a. Gigantism b. Hyperthyroidism c. Cushing syndrome d. Growth hormone deficiency
D (Hypopituitarism can lead to a growth hormone deficiency. An overproduction of the anterior pituitary hormones can result in gigantism (caused by excess growth hormone production during childhood), hyperthyroidism, or hypercortisolism (Cushing syndrome).
Type 1 diabetes mellitus is suspected in an adolescent. Which of the following clinical manifestations may be present? a. Moist skin b. Weight gain c. Fluid overload d. Poor wound healing
D (Poor wound healing may be present in an individual with type 1 diabetes mellitus.)
Manifestations of hypoglycemia include which of the following? a. Lethargy b. Thirst c. Nausea and vomiting d. Shaky feeling and dizziness
D (Some of the clinical manifestations of hypoglycemia include shaky feelings; dizziness; difficulty concentrating, speaking, focusing, or coordinating; sweating; and pallor.)
What clinical manifestation occurs with hypoglycemia? a. Lethargy b. Confusion c. Nausea and vomiting d. Weakness and dizziness
D (Some of the clinical manifestations of hypoglycemia include weakness; dizziness; difficulty concentrating, speaking, focusing, and coordinating; sweating; and pallor. Lethargy, confusion, and nausea and vomiting are manifestations of hyperglycemia)
A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by which dietary intervention? a. Sports drink and fruit b. Glucose tabs and protein c. Glass of water and crackers d. Milk and peanut butter on bread
D (Symptoms of hypoglycemia are treated with a rapid-releasing sugar source followed by a complex carbohydrate and protein. Milk supplies lactose and a more prolonged action from the protein. The bread is a complex carbohydrate, which with the peanut butter provides a sustained action. The sports drink contains primarily simple carbohydrates. The fruit contains additional carbohydrates. A protein source is needed for sustained action. The glucose tabs are simple carbohydrates. Complex carbohydrates are needed with the protein. Crackers are a complex carbohydrate, but protein is needed to stabilize the blood sugar.)
A child eats some sugar cubes after experiencing symptoms of hypoglycemia. This rapid-releasing sugar should be followed by which of the following? a. Fat b. Fruit juice c. Several glasses of water d. Complex carbohydrate and protein
D (Symptoms of hypoglycemia are treated with a rapid-releasing sugar source followed by a complex carbohydrate and protein.)
The nurse is discussing with a child and family the various sites used for insulin injections. What site usually has the fastest rate of absorption? a. Arm b. Leg c. Buttock d. Abdomen
D (The abdomen has the fastest rate of absorption but the shortest duration. The arm has a fast rate of absorption but a short duration. The leg has a slow rate of absorption but a long duration. The buttock has the slowest rate of absorption and the longest duration)
The parent of a child with diabetes mellitus asks the nurse when urine testing will be necessary. The nurse should explain that urine testing for: a. glucose is needed before administration of insulin. b. glucose is needed four times a day. c. glycosylated hemoglobin is required. d. ketonuria should be done when it is suspected.
D (Urine testing is still performed to detect evidence of ketonuria.)
What is a condition that can result if hypersecretion of growth hormone (GH) occurs after epiphyseal closure? a. Cretinism b. Dwarfism c. Gigantism d. Acromegaly
D Excess GH after closure of the epiphyseal plates results in acromegaly. Cretinism is associated with hypothyroidism. Dwarfism is the condition of being abnormally small. Gigantism occurs when there is hypersecretion of GH before the closure of the epiphyseal plates.
Clinical manisfestations of Diabetes Insipidus in infants is irritability that is relieved with feedings of ______ and not _____ : dehydration often occurs. -Teach parents difference b/w diabetes and diabetes insipidus. -Accurate I and O's -Monitor for signs of fluid over load -implement seizure precautions - Evaluate electrolytes hypernatremia,
water, milk
Type of diet required for patients with PKU?
•LOW PHENYLALANINE DIET: AVOID HIGH PROTEIN FOODS (MEATS & DAIRY PRODUCTS) (& PRODUCTS CONTAINING ASPARTAME AS THEY CONTAIN LARGE AMOUNTS OF PHE)