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Hypocalcaemia
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Hypocalcemia
Synonyms
Hypocalcemia
Calcium within the periodic table
Specialty
Endocrinology
Symptoms
Numbness, muscle spasms, seizures, confusion[1][2]
Complications
Cardiac arrest.[1][2]
Causes
Hypoparathyroidism, vitamin D deficiency, kidney failure, pancreatitis, calcium channel blocker overdose, rhabdomyolysis, tumor lysis syndrome, bisphosphonates[1][2]
Diagnostic method
Blood serum < 2.1 mmol/L (corrected calcium or ionized calcium)[1][3][2]
Treatment
Calcium supplements, vitamin D, magnesium sulfate.[1][2]
Frequency
~18% of people in hospital[4]
Hypocalcaemia, also spelled hypocalcemia, is low calcium levels in the blood serum.[5] The normal range is 2.1–2.6 mmol/L (8.8–10.7 mg/dl, 4.3–5.2 mEq/L) with levels less than 2.1 mmol/l defined as hypocalcemia.[1][3][6] Mildly low levels that develop slowly often have no symptoms.[2][4] Otherwise symptoms may include numbness, muscle spasms, seizures, confusion, or cardiac arrest.[1][2]
Common causes include hypoparathyroidism and vitamin D deficiency.[2] Others causes include kidney failure, pancreatitis, calcium channel blocker overdose, rhabdomyolysis, tumor lysis syndrome, and medications such as bisphosphonates.[1] Diagnosis should generally be confirmed with a corrected calcium or ionized calcium level.[2] Specific changes may be seen on an electrocardiogram (ECG).[1]
Initial treatment for severe disease is with intravenous calcium chloride and possibly magnesium sulfate.[1] Other treatments may include vitamin D, magnesium, and calcium supplements.[2] If due to hypoparathyroidism, hydrochlorothiazide, phosphate binders, and a low salt diet may also be recommended.[2] About 18% of people who are being treated in hospital have hypocalcemia.[4]
Contents
1 Signs and symptoms
2 Causes
3 Mechanism
4 Diagnosis
5 Management
6 See also
7 References
8 External links
Signs and symptoms[edit]
Purpura
The neuromuscular symptoms of hypocalcemia are caused by a positive bathmotropic effect due to the decreased interaction of calcium with sodium channels. Since calcium blocks sodium channels and inhibits depolarization of nerve and muscle fibers,reduced calcium lowers the threshold for depolarization.[7] The symptoms can be recalled by the mnemonic "CATs go numb" - convulsions, arrhythmias, tetany, and numbness in the hands and feet and around the mouth.[citation needed]
Petechiae which appear as on-off spots, then later become confluent, and appear as purpura (larger bruised areas, usually in dependent regions of the body).
Oral, perioral and acral paresthesias, tingling or 'pins and needles' sensation in and around the mouth and lips, and in the extremities of the hands and feet. This is often the earliest symptom of hypocalcaemia.
Carpopedal and generalized tetany (unrelieved and strong contractions of the hands, and in the large muscles of the rest of the body) are seen.
Latent tetany
Trousseau sign of latent tetany (eliciting carpal spasm by inflating the blood pressure cuff and maintaining the cuff pressure above systolic)
Chvostek's sign (tapping of the inferior portion of the cheekbone will produce facial spasms)[8]
Tendon reflexes are hyperactive
Life-threatening complications
Laryngospasm
Cardiac arrhythmias
Effects on cardiac output
Negative chronotropic effect, or a decrease in heart rate.
Negative inotropic effect, or a decrease in contractility
ECG changes include the following:
Intermittent QT prolongation, or intermittent prolongation of the QTc (corrected QT interval) on the EKG (electrocardiogram) is noted. The implications of intermittent QTc prolongation predisposes to life-threatening cardiac electrical instability (and this is therefore a more critical condition than constant QTc prolongation). This type of electrical instability puts the patient at high risk of torsades de pointes, a specific type of ventricular tachycardia which appears on an EKG (or ECG) as something which looks a bit like a sine wave with a regularly increasing and decreasing amplitude. (Torsades de pointes can cause death, unless the patient can be medically or electrically cardioverted and returned to a normal cardiac rhythm.)
Causes[edit]
Hypoparathyroidism is a common cause of hypocalcemia. Calcium is tightly regulated by the parathyroid hormone (PTH). In response to low calcium levels, PTH induces the kidneys to reabsorb calcium, the kidneys to increase production of calcitriol (the active form of vitamin D) thereby increasing intestinal absorption of calcium, and the bones to release calcium. These actions lead to a re-balance in the blood calcium levels. However, in the setting of absent, decreased, or ineffective PTH hormone, the body loses this regulatory function, and hypocalcemia ensues. Hypoparathyroidism is commonly due to surgical destruction of the parathyroid glands via parathyroidectomy or neck dissection for head and neck cancers. Hypoparathyroidism may also be due to autoimmune destruction of the glands.[citation needed]
Eating disorders
Prolonged vomiting (e.g. with a viral illness)
Exposure to mercury, including infantile acrodynia
Decreased magnesium.[9]
Excessive dietary zinc, as with supplementation (causes rapid hypocalcemia).
Prolonged use of medications/laxatives containing magnesium
Chelation therapy for metal exposure, particularly EDTA
Osteoporosis treatment or preventive agents, such as bisphosphonates and denosumab.
Agents for the treatment of hypercalcemia, such as Calcitonin.
Chronic kidney failure
Absent active vitamin D
Decreased dietary intake
Decreased sun exposure
Defective Vitamin D metabolism
Anticonvulsant therapy
Vitamin-D dependent rickets, type I
Ineffective active vitamin D
Intestinal malabsorption
Vitamin-D dependent rickets, type II
Pseudohypoparathyroidism
Severe acute hyperphosphataemia
Tumour lysis syndrome
Acute kidney failure
Rhabdomyolysis (initial stage)
Exposure to hydrofluoric acid which can be fatal if 2.5% of skin is exposed[10]
As a complication of pancreatitis
Alkalosis, often caused by hyperventilation
As blood plasma hydrogen ion concentration decreases, caused by respiratory or metabolic alkalosis, the concentration of freely ionized calcium, the biologically active component of blood calcium, decreases. Because a portion of both hydrogen ions and calcium are bound to serum albumin, when blood becomes alkalotic, the bound hydrogen ions dissociate from albumin, freeing up the albumin to bind with more calcium and thereby decreasing the freely ionized portion of total serum calcium. For every 0.1 increase in pH, ionized calcium decreases by about 0.05 mmol/L. This hypocalcaemia related to alkalosis is partially responsible for the cerebral vasoconstriction that causes the lightheadedness, fainting, and paraesthesia often seen with hyperventilation.
Tetany may also be seen with this condition.
Neonatal hypocalcemia
Very low birth weight (less than 1500 grams)
Gestational age less than 32 weeks
Mechanism[edit]
Physiologically, blood calcium is tightly regulated within a narrow range for proper cellular processes. Calcium in the blood exists in three primary states: bound to proteins (mainly albumin), bound to anions such as phosphate and citrate, and as free (unbound) ionized calcium. Only the ionized calcium is physiologically active. Normal blood calcium level is between 8.5 to 10.5 mg/dL (2.12 to 2.62 mmol/L) and that of ionized calcium is 4.65 to 5.25 mg/dL (1.16 to 1.31 mmol/L).[11]
Diagnosis[edit]
An ECG of a person with hypocalcemia
Because a significant portion of calcium is bound to albumin, any alteration in the level of albumin will affect the measured level of calcium. A corrected calcium level based on the albumin level is: Corrected calcium (mg/dL) = measured total Ca (mg/dL) + 0.8 * (4.0 - serum albumin [g/dL]).[12]
Management[edit]
Calcitrol
Management of this condition includes:[citation needed]
Intravenous calcium gluconate 10% can be administered, or if the hypocalcaemia is severe, calcium chloride is given instead. This is only appropriate if the hypocalcemia is acute and has occurred over a relatively short time frame. But if the hypocalcemia has been severe and chronic, then this regimen can be fatal, because there is a degree of acclimatization that occurs. The neuromuscular excitability, cardiac electrical instability, and associated symptoms are then not cured or relieved by prompt administration of corrective doses of calcium, but rather exacerbated. Such rapid administration of calcium would result in effective over correction – symptoms of hypercalcemia would follow.
However, in either circumstance, maintenance doses of both calcium and vitamin-D (often as 1,25-(OH)2-D3, i.e. calcitriol) are often necessary to prevent further decline
See also[edit]
Calcium metabolism
Hypercalcaemia
Milk fever (hypocalcemia in animals)
Calcium deficiency (plant disorder)
Hypomagnesemia with secondary hypocalcemia
References[edit]
^ Jump up to: a b c d e f g h i j Soar, J; Perkins, GD; Abbas, G; Alfonzo, A; Barelli, A; Bierens, JJ; Brugger, H; Deakin, CD; Dunning, J; Georgiou, M; Handley, AJ; Lockey, DJ; Paal, P; Sandroni, C; Thies, KC; Zideman, DA; Nolan, JP (October 2010). "European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution". Resuscitation. 81 (10): 1400–33. doi:10.1016/j.resuscitation.2010.08.015. PMID 20956045.
^ Jump up to: a b c d e f g h i j k Fong, J; Khan, A (February 2012). "Hypocalcemia: updates in diagnosis and management for primary care". Canadian Family Physician. 58 (2): 158–62. PMC 3279267. PMID 22439169.
^ Jump up to: a b Pathy, M.S. John (2006). "Appendix 1: Conversion of SI Units to Standard Units". Principles and practice of geriatric medicine. 2 (4. ed.). Chichester [u.a.]: Wiley. p. Appendix. doi:10.1002/047009057X.app01. ISBN 9780470090558.
^ Jump up to: a b c Cooper, MS; Gittoes, NJ (7 June 2008). "Diagnosis and management of hypocalcaemia". BMJ (Clinical Research Ed.). 336 (7656): 1298–302. doi:10.1136/bmj.39582.589433.be. PMC 2413335. PMID 18535072.
Jump up ^ LeMone, Priscilla; Burke, Karen; Dwyer, Trudy; Levett-Jones, Tracy; Moxham, Lorna; Reid-Searl, Kerry (2015). Medical-Surgical Nursing. Pearson Higher Education AU. p. 237. ISBN 9781486014408. Archived from the original on 2016-10-02.
Jump up ^ Minisola, S; Pepe, J; Piemonte, S; Cipriani, C (2 June 2015). "The diagnosis and management of hypercalcaemia". BMJ (Clinical Research Ed.). 350: h2723. doi:10.1136/bmj.h2723. PMID 26037642.
Jump up ^ Armstrong, C. M.; Cota, Gabriel (1999). "Calcium block of Na+ channels and its effect on closing rate". Proceedings of the National Academy of Sciences of the United States of America. 96 (7): 4154–4157. Bibcode:1999PNAS...96.4154A. doi:10.1073/pnas.96.7.4154. PMC 22436. PMID 10097179.
Jump up ^ Durlach, J; Bac, P; Durlach, V; Bara, M; Guiet-Bara, A (June 1997). "Neurotic, neuromuscular and autonomic nervous form of magnesium imbalance". Magnesium Research. 10 (2): 169–95. PMID 9368238.
Jump up ^ Swaminathan, R. (2003). "Magnesium metabolism and its disorders". The Clinical Biochemist. Reviews. 24 (2): 47–66. ISSN 0159-8090. PMC 1855626. PMID 18568054.
Jump up ^ Sheridan, R.L.; Ryan, C.M.; Quinby, W.C.; Blair, J.; Tompkins, R.G.; Burke, J.F. (1995). "Emergency management of major hydrofluoric acid exposures". Burns. 21 (1): 62–64. doi:10.1016/0305-4179(95)90785-x.
Jump up ^ Siyam, Fadi F.; Klachko, David M. (2013). "What Is Hypercalcemia? The Importance of Fasting Samples". Cardiorenal Medicine. 3 (4): 232–238. doi:10.1159/000355526. ISSN 1664-3828. PMC 3901605. PMID 24474951.
Jump up ^ Fluids & Electrolytes: A 2-in-1 Reference for Nurses. Lippincott Williams & Wilkins. 2006. p. 122. ISBN 9781582554259. Archived from the original on 2017-03-19.
External links[edit]
Classification
D
ICD-10: E83.5
External resources
eMedicine: article/241893
Patient UK: Hypocalcaemia
show
v
t
e
Electrolyte imbalance and acid–base imbalance (E86–E87, 276)
Volume status
Volume contraction (dehydration/hypovolemia)
Hypervolemia
Electrolyte
Sodium
High
Hypernatremia
Salt poisoning
Low
Hypotonic
Isotonic
Potassium
High
Low
Chloride
High
Low
Calcium
High
Low
Acid–base
Acidosis
Metabolic: High anion gap
Ketoacidosis
Diabetic ketoacidosis
Alcoholic ketoacidosis
Lactic
Normal anion gap
Hyperchloremic
Renal tubular
Respiratory
Alkalosis
Metabolic
Contraction alkalosis
Respiratory
Both
Mixed disorder of acid-base balance
show
v
t
e
Inborn error of metal metabolism (E83, 275)
Transition metal
Fe
high:
Primary iron overload disorder: Hemochromatosis/HFE1
Juvenile/HFE2
HFE3
African iron overload/HFE4
Aceruloplasminemia
Atransferrinemia
Hemosiderosis
deficiency:
Iron deficiency
Cu
high:
Copper toxicity
Wilson's disease
deficiency:
Copper deficiency
Menkes disease/Occipital horn syndrome
Zn
high:
Zinc toxicity
deficiency:
Acrodermatitis enteropathica
Electrolyte
Na+ and K+
see Template:Water-electrolyte imbalance and acid-base imbalance
PO43−
high:
Hyperphosphatemia
deficiency:
Hypophosphatemia
alkaline phosphatase
Hypophosphatasia
Mg2+
high:
Hypermagnesemia
deficiency:
Hypomagnesemia
Ca2+
high:
Hypercalcaemia
Milk-alkali syndrome (Burnett's)
Calcinosis (Calciphylaxis, Calcinosis cutis)
Calcification (Metastatic calcification, Dystrophic calcification)
Familial hypocalciuric hypercalcemia
deficiency:
Hypocalcaemia
Osteomalacia
Pseudohypoparathyroidism (Albright's hereditary osteodystrophy)
Pseudopseudohypoparathyroidism
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Membership levels of the Girl Scouts of the USA
From Wikipedia, the free encyclopedia
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Since 2008, Girl Scouts of the USA have had five age levels: Daisy, Brownie, Junior, Cadette, and Senior. In 2011 they added the new sixth level of Ambassadors.[1] Girl Scouts move or "bridge" to the next level, usually at the end of the school year they reach the age of advancing. They are considered in the appropriate level based on their grade on October 1, the start of each new Girl Scout year. There are exceptions for "special needs" but Girl Scouts who are "young in grade" have not been specifically considered. Each year of membership in Girl Scouting is represented on the uniform by a small, golden, six-pointed membership star (one per year) with colored background discs which represent a level. Girl Scouts used to wear similar uniforms to other groups in WAGGGS. Now a white shirt and khaki bottom is accepted for all levels.[2]
Contents
1 Daisies
2 Brownies
3 Juniors
4 Cadettes
5 Seniors
6 Ambassadors
7 Adults
7.1 Campus Girl Scouts
8 History
9 See also
10 References
11 External links
Daisies[edit]
Daisy is the initial level of Girl Scouting. Named for Juliette "Daisy" Gordon Low, they are in kindergarten and first grade (around ages 5–7).[3][4] They meet in minimally groups of five girls with two adult leaders who help the girls plan activities to introduce them to Girl Scouts.
Daisies earn the Promise Center and Petals, which focus on the Girl Scout Law and are placed on the front of the tunic in a daisy design. They also earn Leaves and Journey Leadership Awards. Their uniform consists of a light blue tunic. They may also wear their tunic with a white shirt and khaki bottoms or with an official Girl Scout Daisy uniform.[2] The Girl Scout Membership Star is worn with blue membership disks[5] and they wear the Girl Scout Daisy Membership Pin.
Daisies use the Girl's Guide to Girl Scouting for Daisies[6] and the National Leadership Journeys[7] to work on activities, may camp only with a parent present, and have the option to sell Girl Scout cookies. They may earn the Daisy Safety Award and the Bridge to Brownies Award.[8]
Brownies[edit]
Brownies are in second and third grades (around ages 7–9).[3][9] and earn triangular shaped Brownie Leadership Journey Awards and National Proficiency Badges. Their uniform consists of a brown vest or sash which may be worn with a white shirt and khaki bottoms or with an official Brownie uniform.[2] The Girl Scout Membership Star is worn with green membership disks,[5] and they wear the Brownie Membership Pin.
Brownies use the Girl's Guide to Girl Scouting for Brownies[6] and the National Leadership Journeys[7] to work on badges and activities. They may earn the Bridge to Juniors Award and the Brownie Safety Award.[10]
Unlike some of the other levels, the name Brownie is commonly used with Girl Scout/Girl Guide organizations around the world and has its origin from Brownies in the British Girl Guides.
Juniors[edit]
Juniors are in fourth and fifth grades (around ages 9–11).[3][11] Their uniform is a green vest or sash which may be worn with a white shirt and khaki bottoms.[2]
Juniors are the first level to wear the official Girl Scout Membership Pin on their uniform. The Girl Scout Membership Star is worn with yellow membership disks.[5] They use the Girl's Guide to Girl Scouting for Juniors[6] and the National Leadership Journeys[7] to work on badges and activities. They earn circle shaped Junior Leadership Journey Awards and National Proficiency Badges. Badges require more skill at this level as the girls gain proficiency. They may earn the Girl Scout Junior Safety Award, the Junior Aide Award, and the Bridge to Cadettes Award.[12]
Juniors are eligible to earn the Bronze Award, the highest award in Girl Scouting available at this level.
Cadettes[edit]
Cadettes are Girl Scouts who are in sixth, seventh, and eighth grades (around ages 11–14).[3][13] Their uniform is a khaki vest or sash with white shirts and khaki bottoms.[2] They wear the official Girl Scout Membership Pin on their uniform. The Girl Scout Membership Star is worn with white membership disks.[5]
Cadettes use the Girl's Guide to Girl Scouting for Cadettes[6] and the National Leadership Journeys[7] to earn diamond shaped badges. Typically, Girl Scouts at this level are encouraged to assume leadership roles within them, such as assisting in leading and coordinating service unit or association events. They may also earn the Cadette Program Aide award, the Cadette Community Service Bar, the Cadette Service to Girl Scouting Bar, the Cadette Safety Award and the Bridge to Senior Award.[14] They are eligible to earn the Silver Award, which is the highest award available to girls at this level.
Seniors[edit]
Seniors are Girl Scouts who are in ninth and tenth grade (around ages 14–16).[13] Their wear the same uniform as Cadettes—however, the disks for their membership stars are red and their badges are a rectangular shape.[2][5]
Seniors use the Girl's Guide to Girl Scouting for Seniors[6] and the National Leadership Journeys[7] to earn badges. They are typically encouraged to create and lead activities for the younger Girl Scouts, and to take a leadership role in organizing and assisting with Council and service unit/association events and activities. They may earn the Counselor-in-Training (CIT), the Volunteer-in-Training (VIT), the Girl Scout Senior Safety Award, the Gold Torch Award, the Senior Community Service Bar, the Senior Service to Girl Scouting Bar and the Bridge to Girl Scout Ambassador award.[15]
Seniors are eligible to earn the Gold Award.
Ambassadors[edit]
Ambassadors are Girl Scouts who are in eleventh and twelfth grade (around ages 16-18).[13] They wear the same khaki colored vest or sash as Cadettes and Seniors.[2] The Girl Scout Membership Star is worn with navy membership disks.[5]
Ambassadors use the Girl's Guide to Girl Scouting for Ambassadors[6] and the National Leadership Journeys[7] to earn badges that are shaped like an octagon. They may earn the Counselor-in-Training (CIT), the Counselor-in-Training (CIT) II, the Volunteer-in-Training (VIT), the Ambassador Community Service Bar, the Ambassador Service to Girl Scouting Bar, the Gold Torch Award, the Ambassador Safety Award, and the Bridge to Adult Award.[16]
Ambassadors are eligible to earn the Gold Award.
Adults[edit]
Adults, both men and women, can join Girl Scouts and participate as leaders or in other volunteer roles. They do not need to have a child in the program in order to volunteer with Girl Scouts.[17]
Campus Girl Scouts[edit]
Young adults who attend an institute of higher learning may join or start a Campus Girl Scout group on their campus. While they are full adult members in Girl Scouts and do not form a troop or sell cookies, joining them allows them to get involved with their campus community and beyond. They may lead troops, volunteer for Council events, help with paperwork or the cookie sale, complete service projects- their activities are driven by the members of the group.[18]
History[edit]
Initially the United States Girl Scout program, started in 1912, had one level for girls ages ten through seventeen, but it soon added two more levels. Brownies for younger girls was officially recognized in the mid-1920s though it had existed earlier. At the same time older girls (over eighteen or over sixteen if First Class Scouts) became known as Senior Scouts.
In 1938 age divisions were set as
Brownies (ages seven through nine)
Intermediates (ages ten through thirteen)
Seniors (ages fourteen through seventeen)
In 1963 this was rearranged to
Brownies (ages seven through nine)
Juniors (ages nine through eleven)
Cadettes (ages eleven through fourteen)
Seniors (ages fourteen through seventeen)
In the 1970s the age divisions were
Pixies (ages five through six)
Brownies (ages seven through nine)
Juniors (ages nine through eleven)
Cadettes (ages eleven through fourteen)
Seniors (ages fourteen through seventeen)
In 1984, the Daisy program for kindergartners (age five) was introduced, and around 2003 the Studio 2B program for girls eleven through seventeen was introduced as a way to give older girls more options in Girl Scouts, although many girls still called themselves Cadettes and Seniors. STUDIO 2B was discontinued as a program option in 2007.
Daisies (5-6 years old or in kindergarten)
Brownies (6–8 years old or in grades 1–3)
Juniors (8–12 years old or in grades 4–6. In some situations, girls age eight and in third grade may be Juniors.)
Cadettes (12–13 years old or in grades 7–8)
Seniors (14–17 years old or in grades 9–12)[19]
In 2008 another reorganization took place. The Ambassador level was added. All levels were changed to have Girl Scouts at the start of their name, e.g. "Girl Scout Brownies" instead of "Brownie Girl Scouts", and levels were changed to be by grade only instead of by age or grade.
Daisies (grades K–1, ages 5-7)
Brownies (grades 2–3, ages 7-9)
Juniors (grades 4–5, ages 9-11)
Cadettes (grades 6–8, ages 11-14)
Seniors (grades 9–10, ages 14-16)
Ambassadors (grades 11–12, ages 16-18)
Outside the age level programs, there have been somewhat separate programs for Mariner Scouts (1934–present) and Wing Scouts (1941–1970s).
In addition, there are Girl Scouts known as Juliettes, who are independent of any troop due to lack of a troop to join or because other commitments do not allow them to actively participate with available troops. A Juliette is still placed in her appropriate grade level and works on program as would any other girl her age in a regular troop. A number of Girl Scout councils are discouraging the use of "Juliettes".
See also[edit]
Scouting portal
References[edit]
Jump up ^ "What is Girl Scouting?". girlscouts.org. Girl Scouts of the USA. Retrieved July 18, 2013.
^ Jump up to: a b c d e f g "Uniforms: Official Dress Code". girlscouts.org. Girl Scouts of the USA. Retrieved July 18, 2013.
^ Jump up to: a b c d "Join Us: Girls". Girls Scouts of the USA. Retrieved April 10, 2009.
Jump up ^ "Girl Scout Daisy, grades Pre-K - 1". Girl Scouts of the USA. Retrieved April 10, 2009.
^ Jump up to: a b c d e f "Girl Scout Membership Star". girlscoutshop.com. Girl Scouts of the USA. Retrieved July 18, 2013.
^ Jump up to: a b c d e f "Girl's Guide to Girl Scouting". girlscouts.org. Girl Scouts of the USA. Retrieved July 18, 2013.
^ Jump up to: a b c d e f "Welcome to the Journeys". girlscouts.org. Girl Scouts of the USA. Retrieved July 18, 2013.
Jump up ^ "Insignia List: Girl Scout Daisies". girlscouts.org. Girl Scouts of the USA. Retrieved July 18, 2013.
Jump up ^ "Girl Scout Brownie". Girl Scouts of the USA. Retrieved April 10, 2009.
Jump up ^ "Insignia List: Girl Scout Brownie". girlscouts.org. Girl Scouts of the USA. Retrieved July 18, 2013.
Jump up ^ "Girl Scout Junior". Girl Scouts of the USA. Retrieved April 10, 2009.
Jump up ^ "Insignia List: Girl Scout Juniors". girlscouts.org. Girl Scouts of the USA. Retrieved July 18, 2013.
^ Jump up to: a b c "Girl Scout Cadette Senior Ambassador". Girl Scouts of the USA. Retrieved April 10, 2009.
Jump up ^ "Insignia List: Girl Scout Cadettes". girlscouts.org. Girl Scouts of the USA. Retrieved July 18, 2013.
Jump up ^ "Insignia List: Girl Scout Seniors". girlscouts.org. Girl Scouts of the USA. Retrieved July 18, 2013.
Jump up ^ "Insignia List: Girl Scout Ambassadors". girlscouts.org. Girl Scouts of the USA. Retrieved July 18, 2013.
Jump up ^ "Insignia List: Girl Scout Adults". girlscouts.org. Girl Scouts of the USA. Retrieved July 18, 2013.
Jump up ^ "Campus Girl Scouts". Girl Scouts of the USA. Archived from the original on August 1, 2008. Retrieved February 12, 2007.
Jump up ^ http://www.main.org/gsusa/division.htm Lone Star Girl Scout Council
External links[edit]
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