2-5-16-DM1 Case (Kirila) Flashcards Preview

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Flashcards in 2-5-16-DM1 Case (Kirila) Deck (14):
1

Skin tenting (turgor) is a sign of ___

Dehydration

2

Describe Kussmaul breathing:

-Metabolic acidosis (DM)
-hyperpnoea
-Rapid/deep breathing

Ketones (DKA)
Uremia
Sepsis
Salicylates
Methanol
Aldehydes
(U)
Lactic acidosis

3

List signs for DKA:

-Kussmaul respirations-rapid/deep
-Acetone (fruity) breath odor
-Dry mucous membranes
-Poor skin turgor
-Tachycardia
-Hypotension
-Fever
-Abdominal tenderness

4

Plasma potassium is expected to ___ during DKA

Increase--> since acidosis causes K+ to shift out of cells

5

What is expected of the anion gap during DKA?

Increased (should be between 5-16 mEq/L)

6

What set of values from a CMP are used to calculate the anion gap?

Na, Cl, and CO2 (or HCO3)

7

What does MUDPILES stand for in High Anion Gap Acidosis?

Methanol
Uremia
DKA
Paraldehyde
Isopropyl alcohol, Iron, Isoniazid
Lactic acidosis
Ethylene glycol
Salicylates

8

When do you want to consider K+ replacement in DKA?

When serum [K+] is less than 5.5 mEq/L

9

What are contributing factors to the development of type 1 diabetes?

-Genetic susceptibility
-Multiple autoimmune mechanisms possible
-Environmental factors (possible triggers), i.e., Cocksacki, enterovirus

10

What are the most likely predisposing factors for DKA?

-Previously undiagnosed diabetes
-Infection
-Systemic illness
-Dehydration

11

What are features shared by both type 1 and type 2 DM?

-Dehydration
-Insulin deficiency-either absolute or relative
-Glucagon excess-either absolute or relative

12

What is the acute treatment for fluid replacement in DKA?

"1-2-3" rule

-2-3 liters NS (Normal Saline) (0.9%) over first 1-3 hours (5-10 ml/kg/hr)
-Then, 1/2 strength saline (0.45%) at 150 ml/hr
-When glucose reaches 250 mg/dl, switch to D5 1/2 NS (5% dextrose and 0.45% saline) at 100-200 ml/hr

-Fluid deficit is often 3-5 liters

13

What is the acute treatment for insulin administration in DKA?

Regular insulin
-10-20 units IV or IM (IV if possible)
-then, 5-10 units/hr continuous IV (or 0.05-0.1/kg/hr)
-Increase if no response in 1-2 hours-orders can be written with guidelines to titrate

14

What are the mental status changes associated with DM type 1 (AEIOU TIPS)?

Alcohol/acidosis
Epilepsy/Endocrine/Exocrine/Encephalopathy
Infection
Opioid/Overdose
Uremia
Trauma
Insulin
Psychosis
Syncope/Stroke