Adult Endocrine Flashcards
(29 cards)
Guidelines for diagnosis of DM
- FPG (Fasting plasma glucose) values ≥126 mg/dL (7.0 mmol/L).
- Two-hour plasma glucose values of ≥200 mg/dL (11.1 mmol/L) during a 75 g OGTT (Oral Glucose Tolerance Test).
- HbA1C values ≥6.5 percent (48 mmol/mol).
What is the recommended monitering for long term care of DM
- Hemoglobin A1c
- HbA1c
- GHbA1c
- Glycosylated hemoglobin
Differential for mental status changes
AEIOUTIPS
- A – Alcohol
- E – Epilepsy with seizure activity
- I – Infection
- O – Overdose
- U- Uremia
- T – Trauma
- I – Insulin (high or low blood sugar)
- P – Poisoning/Psychosis
- S – Stroke
Differential for abdominal pain mnemonic
BAD GUT PAINS
BAD GUT in abdominal pain differential
B - Bowel obstruction A - Appendicitis, Adenitis (mesenteric) D - Diverticulitis Diabetic Ketoacidosis Dysentary/Diarrhea Drug withdrawal G - Gastroenteritis Gall bladder disease/stones/obstruction/infection U - Urinary tract obstruction or infection T - Testicular Torsion Toxins - Lead, black widow spider bite
PAIN in abdominal pain differential
P - Pneumonia/Pleurisy/Pancreatitis Perforated
bowel/Peptic ulcer/Porphyria
A - Abdominal aneurysm
IN - Infarcted bowel
Infarcted myocardium (AMI-Acute Myocardial Infarction)
Incarcerated hernia
Inflammatory bowel disease
S - Splenic rupture/infarction
Sickle cell pain crisis/Sickle sequestration crisis
High Anion gap acidosis differential
MUDPILES
- Methanol
- Uremia
- Diabetic Ketoacidosis
- Paraldehyde
- Isopropyl Alcohol, Iron, INH (Isoniazid)
- Lactic Acidosis
- Ethylene Glycol
- Salicylates
Treatment of DKA
•Intensive Care Unit • Frequent monitoring of general status, vital signs, glucose and other labs • Acid-base status • Renal function • Potassium and other electrolytes
What is the 123 rule of fluid replacement in DKA
- 2 – 3 liters NS (Normal Saline) (0.9 %) over first 1-3 hours (5-10 ml/kg/hr)
- Then, ½ strength saline (0.45%) at 150 ml/hr
- When glucose reaches 250 mg/dl, switch to D51/2 NS (5% dextrose and 0.45% saline) at 100 – 200 ml/hr
What is the fluid deficit in DKA
Fluid deficit is often 3 – 5 liters
Insulin administration in DKA
Regular Insulin
• 10 – 20 units IV or IM (or 0.15/kg)
• Then, 5-10 units/hr continuous IV (or 0.05 – 0.1/kg/hr
• Increase if no response in 1-2 hrs – orders can be written with guidelines to titrate
When do you consider replacing potassium in DKA
When serum K <5.5 mEQ/L
Initial monitering in DKA
- Bloodwork
- BSG at least hourly
- Electrolytes q 2 – 4 hrs +/- ABG’s
- Clinical status at least hourly
- Vital signs
- B/P, P, R
- Mental status
- Fluid I & O
When do you start intermediae or long acting insulin in the treatment of DKA
- When patient is able to eat as shown by the following:
- Mental status improved
- No nausea/vomiting
- No abdominal pain
- Anion gap normalized
- Allow overlap timing of IV with SQ insulin – usually by 30 – 60 minutes
Symptoms of NKHS
- Polyuria
- Thirst
- Altered mental state
- NOTE: Typically ABSENT are nausea, vomiting, abdominal pain and kussmaul respirations (these and acidosis & ketonemia are more typically seen in DKA)
Fluid replacement in NKHS
• 2 – 3 liters NS (Normal Saline) (0.9 %) over first 1-3 hours
(5-10 ml/kg/hr)
• Fluid deficit is often 8 – 10L
• Reverse over next 24 – 48 hrs using ½ strength saline (0.45%)
• When glucose reaches 250 mg/dl, switch to D51/2 NS (5%
dextrose and 0.45% saline) at 100 – 200 ml/h
What are the differences between DKA and HHS
- Fluid deficit is much greater in NKHS
- Some drugs can contribute to NKHS
- Nausea, vomiting, abdominal pain, ketoacidosis and kussmaul respirations typically absent in NKHS
What are the similarities between DKA and HHS
- Insulin deficiency – absolute or relative
- Glucagon excess – absolute or relative
- Volume depletion
- Mental status changes
- Both are critical conditions needing intensive monitoring
What is the earliest measurable sign of
proteinuria and diabetic effect of nephropathy
Microalbumin
What is done/checked in quarterly diabetes monitoring
- Hgb A1C
- Review SGM (Self Glucose Monitoring) log –download if possible
- Foot inspection for ulcerations etc
What is done/checked in annual diabetes monitoring
- Dilated eye exam
- Urine protein screening (microalbumin/creatinine ratio)
- Monofilament testing
Foot care in diabetes
• Daily inspection – often difficult for patient with dexterity
and visual problems
• Can use “plastic” (to avoid injury from glass) mirror on floor when
getting out of bed
• Family assistance
• Never go barefoot
• Moisturize – but NOT in between or under toes
• Prescription shoes – Medicare will pay for one pair per year
• Podiatry
Most important lifestyle modification in diabetes
physical activity
What is the singe most additive risk for vascular disease in diabetes
cigarette smoking
