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

Endocrine > 2-5-16-DM1 Case (Kirila) > Flashcards

Flashcards in 2-5-16-DM1 Case (Kirila) Deck (14)
Loading flashcards...
1
Q

Skin tenting (turgor) is a sign of ___

A

Dehydration

2
Q

Describe Kussmaul breathing:

A
  • Metabolic acidosis (DM)
  • hyperpnoea
  • Rapid/deep breathing
Ketones (DKA)
Uremia
Sepsis
Salicylates
Methanol
Aldehydes
(U)
Lactic acidosis
3
Q

List signs for DKA:

A
  • Kussmaul respirations-rapid/deep
  • Acetone (fruity) breath odor
  • Dry mucous membranes
  • Poor skin turgor
  • Tachycardia
  • Hypotension
  • Fever
  • Abdominal tenderness
4
Q

Plasma potassium is expected to ___ during DKA

A

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

5
Q

What is expected of the anion gap during DKA?

A

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

6
Q

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

A

Na, Cl, and CO2 (or HCO3)

7
Q

What does MUDPILES stand for in High Anion Gap Acidosis?

A
Methanol
Uremia
DKA
Paraldehyde
Isopropyl alcohol, Iron, Isoniazid
Lactic acidosis
Ethylene glycol
Salicylates
8
Q

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

A

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

9
Q

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

A
  • Genetic susceptibility
  • Multiple autoimmune mechanisms possible
  • Environmental factors (possible triggers), i.e., Cocksacki, enterovirus
10
Q

What are the most likely predisposing factors for DKA?

A
  • Previously undiagnosed diabetes
  • Infection
  • Systemic illness
  • Dehydration
11
Q

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

A
  • Dehydration
  • Insulin deficiency-either absolute or relative
  • Glucagon excess-either absolute or relative
12
Q

What is the acute treatment for fluid replacement in DKA?

A

“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
Q

What is the acute treatment for insulin administration in DKA?

A

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
Q

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

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