Endocrinology handbook Flashcards

1
Q

What is the diagnostic criteria for diabetic ketoacidosis?

A

Plasma glucose >14mmol/L
Arterial pH <7.3
Plasma HCO3- <15mmol
High anion gap and moderate ketonuria or ketonemia (or high serum BHBA)

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2
Q

What are the investigations for diabetic ketoacidosis in the initial hour?

A

Urine & Blood glucose Urine + plasma ketones or BAHA
Na, K, PO4, Mg, Anion gap (AG)
Urea, Creatinine, Hb Arterial blood gas (ABG)

If indicated:
CXR, ECG
Blood & urine culture and
sensitivity
Urine & serum osmolality PT, APTT

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3
Q

What are the Ix for DKA to keep monitoring after the initial hour?

A

Hourly urine and blood glucose
Na, K, urea, AG (till blood glucose <14 mmol/L)
Repeat ABG if indicated
(intensive monitoring of electrolytes
and acid/base is crucial in the first 24-48 hours)

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4
Q

What is the parameters to be monitored in DKA?

A

Hourly BP/pulse, respiratory rate, conscious level, urine output, central venous pressure (CVP)
2-hourly temperature

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5
Q

What is the management of patient with diabetic ketoacidosis in the inital hour and susbequent hours?

A
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6
Q

What is the management for thyroid storm patient?

A
  1. Close monitoring: often need CVP, Swan Ganz, cardiac monitor, ICU care if possible
  2. Hyperthermia: paracetamol, physical cooling> dehydration: IV fluid, glucose, vitamin (thiamine)
  3. Propylthiouracil, hydrocortisone, B blockers (exclude asthma): propranolol. If B blockers are contraindicated, consider diltiazem
  4. 1 hour later, use iodide to block hormone release: 6-8 drops Lugols solution
  5. Consider Li2Co3 250mg q6h to achieve Li level 0.6-1.0mmol/L
  6. Consider plasmapharesis adn charcoal haemoperfusion for desperate cases
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7
Q

What is classical presentation of phaeochromocytoma?
What is the ix?
What is management and drugs used?

A

Presentation: classical triad of headache, sweating and tachcyardia; young/severe/resistant hypertension, adrenal incidentaloma
Biochemical confirmation by measuring urine catecholamines, fractionated metanephrines and normetanephrines
Preoperative localization and staging by anatomical and functional scan
Alpha blokcers: phenoxybenzamine, prazosin, doxazosin

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8
Q

What is the possible pattern of presentation for post traumatic diabetes insipidus?

A

Phase 1: transient DI, duration hours to days
Phase 2: antiduresis, duration 2-14 days
Phase 3: return of DI (may be permanent)

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9
Q

What to monitor in acute post op/post trauma diabetes insipidus?
What is the management of post traumatic DI?

A
  1. Monitor I/O, BW, serum sodium and urine osmolarity closely (q4h initially, then daily)
    * Able to drink, thirst sensation intact and fully consious: oral hydration, allow patient to drink as thirst dictates)
    * Impaired consiousness and thirst sensation
    Fluid replacement as D5 or 1/2:1/2 solution
    DDAVP 1-4mg (0.5-1ml) q12-24 hr sc/iv. Allow some polyuria to return before next dose. Give each successive dose only if urine volume >200ml/hr in successive hours

Stable cases
Give oral DDAVP 100-200mg BD to TDS or 60-120mg BD to TDS to maintain urine output of 1-2L/day

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10
Q

What is the diagnostic criteria for diabetic hyperosmolar hyperglycemic states?
What is the management principles?

A
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11
Q

What is the preop management of DM patients?

A
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12
Q

What is the management of DM patients on the day of operation for major surgery?

A
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13
Q

What is the management of DM patients on the day of operation for minor surgery?

A
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14
Q

What is the management of DM patients post op care?

A
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15
Q

What is insulin therapy for type 2DM?

A
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16
Q

What is insulin therapy for type 1DM?

A
17
Q

What are the tests for hypoglycemia?
What is treatment?

A
18
Q

How to manage myxoedema coma?

A
19
Q

Ix for addisonian crisis

A
20
Q

Tx for suspected addisonian crisis?

A
21
Q

Relative potencies of different steroids?

A
22
Q

Indications for steroid cover for surgery/trauma?

A