Pediatric Endocrinology Consultation Note (Inpatient)

Date/Time: [Consult order time and evaluation time] (Include both if different; note time zone.)

Patient Location: [Unit/room/bed]

Consultant(s): [Name(s), credentials, service]

Requesting Service/Provider: [Service and clinician name]

Mode: [in-person / chart review / telephone]

Source(s) of History: [patient / parent or guardian / chart / outside records / bedside nurse / interpreter] (Note limitations such as patient intubated, parent unavailable, or language barrier; include interpreter ID if used.)

Reason for Consult

[Specific clinical question(s) from primary team, quoted or precisely paraphrased; urgency or time sensitivity; decisions requested from Endocrinology]

Brief Summary

[1–2 sentence synopsis: patient age, relevant history, admission reason, hospital day, endocrine issue, current stability] (Include key context such as NPO status, TPN/tube feeds, dextrose delivery, steroid exposure, sepsis, or upcoming surgery.)

Immediate Recommendations

(Omit this section if there are no time-sensitive or safety-critical actions.)

• [Actionable item with timing/frequency, monitoring parameters and thresholds, responsible team]
• [Contingency/safety trigger and immediate response, including rescue thresholds and escalation criteria]

HPI

[Narrative focused on consult question: onset, timeline, progression, precipitating factors, prior evaluations and treatments with response]

Nutrition/Glucose Exposure Context: [PO intake; NPO periods with timing; tube feed formula/rate/schedule; TPN composition and dextrose infusion rate; interruptions to dextrose delivery or feeds]

(Tailor to indication: for hyperglycemia/diabetes include polyuria/polydipsia, weight change, ketosis symptoms, prior A1c, home regimen, steroid or atypical antipsychotic exposure. For hypoglycemia include timing relative to feeds/fasting, documented glucose values with timing, insulin/sulfonylurea exposures, liver/adrenal/pituitary risk factors. For adrenal concerns include steroid history with last dose, prior crises, hyperpigmentation, and surgical timing if perioperative.)

Pertinent History

(Include only elements that inform inpatient endocrine decisions; omit categories not relevant to the consult question.)

Endocrine History: [Prior endocrine diagnoses; insulin regimen or pump/CGM use and settings; adherence and barriers; prior DKA/HHS/hypoglycemia events]

PMH: [Relevant comorbidities affecting endocrine status or management]

PSH: [Relevant surgeries impacting endocrine function or current care]

Birth History: [Gestational age, neonatal hypoglycemia, SGA/LGA, NICU course] (Include only if relevant.)

Family History: [Diabetes with type if known, thyroid disease, adrenal disorders, hypoglycemia syndromes]

Medications

Home Medications: [List with doses/routes/schedules; note source of information and certainty]

Inpatient Medications/Infusions: [Current medications with attention to high-risk endocrine exposures: steroids (agent, dose, route, last dose/time), insulin (type, dose, delivery method), diazoxide/octreotide, thyroid medications, vasopressors, dextrose-containing fluids (concentration and rate), TPN composition (glucose infusion rate), tube feed formula and rate]

(Document uncertain items as "Unknown / unable to obtain" with reason and mitigation steps.)

Allergies

[Drug/food/latex allergies and reaction types] (If unable to verify, state "Unknown / unable to obtain" with reason.)

Objective

Vital Signs: [Most recent and relevant range with times]

Anthropometrics: [Weight (kg), height/length (cm), BMI (kg/m²) if applicable, BSA (m²) or inputs to calculate] (If weight/BSA is unknown and needed for dosing, document as unknown with mitigation steps.)

I/O and Fluid Status: [24h intake/output totals, net balance, signs of dehydration or overload] (Include only if relevant.)

Physical Exam: [General appearance, hydration status, mental status, perfusion; endocrine-relevant findings based on indication: dehydration signs, Kussmaul respirations, Cushingoid features, hyperpigmentation, goiter, hepatomegaly, pubertal staging] (Omit components not assessed; if intentionally deferred, note brief reason.)

Bedside/Device Data:

• [POC glucose values with times and trend]
• [Blood/urine ketones with times]
• [Pump/CGM download summary: time window reviewed, average glucose, time in range, hypoglycemia frequency, notable patterns]
• [Nutrition delivery record: feed/TPN/dextrose interruptions or changes with times]

Pertinent Data Reviewed

(Include only values relevant to the consult question; do not paste full panels.)

• Labs: [Curated results with dates/times and trend context: glucose, bicarbonate/anion gap, electrolytes, renal/hepatic function, beta-hydroxybutyrate, lactate, endocrine labs (cortisol/ACTH, TSH/fT4, etc.), A1c with date, diabetes autoantibodies/C-peptide when applicable] (For hypoglycemia, document whether a critical sample was obtained at time of hypoglycemia and before treatment.)
• Imaging: [Relevant imaging with dates and concise findings] (Include only if it informs endocrine management.)
• Outside Records: [Summarized pertinent data reviewed with dates]

Assessment & Plan

(Order problems by acuity and risk, highest priority first. Clearly state whether Endocrinology will enter orders or is advising the primary team.)

[Problem 1]: [Working diagnosis]

[Concise assessment with key supporting evidence, current status (improving / stable / worsening), differential if uncertain]

• Diagnostics: [Tests to obtain with timing and rationale; specify fasting requirements if any]
• Therapeutics: [Medications/fluids with exact dosing (units, weight- or BSA-based), route, timing; nutrition plan and adjustments]
• Monitoring: [Parameters, frequency, targets, stop/transition criteria]
• Safety/Contingencies: [Thresholds for rescue treatments and escalation; when to call Endocrinology]
• Responsibility: [Endocrinology / Primary Team] to place orders
• Disposition: [Criteria for transfer, step-down, or discharge related to this problem]

[Problem 2]: [Working diagnosis]

(Include additional problems only if explicitly addressed in the consult.)

• [Plan as above]

Condition-Specific Elements: (Include as applicable to the consult indication.)

• Diabetes/Hyperglycemia: [Classification (T1D / T2D / stress hyperglycemia / other) with rationale; DKA/HHS status and transition readiness; insulin plan (basal, prandial strategy, correction scale, hypoglycemia rescue); education status and remaining needs; supplies required; follow-up timing]
• Hypoglycemia Evaluation: [Event characterization; critical sample status and contents; immediate prevention plan (feeding schedule, dextrose support, monitoring frequency, rescue protocol); differential and targeted testing; discharge safety planning including caregiver training and glucagon]
• Adrenal Insufficiency/Perioperative: [Basis for adrenal risk; stress level and stress-dose plan (agent, dose, route, timing, taper); contingency instructions for vomiting/hypotension/inability to take PO; discharge elements including emergency injection training and sick-day rules]
• Thyroid/Pituitary/Other: [Diagnosis-specific management, tests, and monitoring relevant to the inpatient setting]

Discharge / Follow-Up Coordination

(Include when discharge is anticipated within 24–72 hours.)

• Anticipated Discharge: [Date/timeframe and barriers]
• Medications at Discharge: [List with changes highlighted and dosing details]
• Supplies: [Insulin, CGM supplies, meter/strips/lancets, ketone strips, glucagon, sharps container]
• Education: [Skills taught, caregiver competency, remaining needs, written action plans provided]
• Follow-Up: [Endocrinology appointment target timeframe, PCP coordination, outpatient labs needed]
• School/Community: [Care plans or communications as applicable]

Communication

[Contacts made (primary team, bedside RN, diabetes educator, pharmacy, family/caregiver), method (in person / phone / page / secure message), date/time]

[Confirmation of understanding and agreed plan] (If recommendations declined or modified by primary team, document the divergence and rationale.)