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Flashcards in ChemPath Deck (11):
1


• Hyperkalaemia is a side-effect of which of the following drugs?
A. Furosemide
B. Bendroflumethiazide
C. Salbutamol
D. Ramipril

Ramipril - ACE inhibitor, less aldosterone, less K loss,

2


• Hypokalaemia is a side-effect of which of the following drugs?
A. Furosemide
B. parindipril
C. indemetacin
D. spiro

furosemide - delivers lots of Na to co

spiro = hyperK

3

Q1:What occurs first in response to hypoglycaemia?

Suppression of insulin
Release of glucagon
Release of adrenaline
Release of cortisol

Suppression of insulin first

then release of glucagon

adrenaline late
cortisol later

4

C: Peptode
-is the cleavage product of insulin
-is secreted in equimolar amounts to insulin
-has a half-life of 2 hours
-interferes with insulin measurement

-is secreted in equimolar amounts to insulin.

cleavage product of proinsulin --> insulin and c peptide

5

Hypoglycaemia due to excess injected insulin would result in…

- low c-peptide
- high c-peptide

low c-peptide

injection of insulin - switch off own production

6

20 year old female, BMI 17 kg/m2
Lanugo hair noted
Finger prick glucose – 3.8mmol/L
Routine bloods taken
• Doctor rung by lab 1 hr later as plasma glucose 2.6 mmol/L
Most likely cause of low blood sugar…
1. Undertakes strenuous exercise regularly
2. Insulinoma
3. Anorexic with poor liver glycogen stores
4. Laxative abuse

3 - anorexic with poor liver glycogen stores.

7

20 year old female, BMI 17 kg/m2
Lanugo hair noted
Finger prick glucose – 3.8mmol/L
Routine bloods taken
• Doctor rung by lab 1 hr later as plasma glucose 2.6 mmol/L
Most likely cause of low blood sugar…

3. Anorexic with poor liver glycogen stores

what would insulin and c-peptide be?

1Low insulin, low C-peptide
2Low insulin, high C-peptide
3High Insulin, lowC-peptide
4High insulin, high C-peptide




1Low insulin, low C-peptide

Hypoinsulinaemic hypoglycaemia – normal response to hypoglycaemia, insulin production gets switched off.

when blood glucose goes low - insulin is off, glucagon is on

8

Case 2 - 1 day old neonate - jittery, not-feeding
Premature – 34 weeks gestation
Lab glucose 1.9 mmol/L
Glucose improved on feeding, but low blood glucose 4 hours after feed.
3-hydroxybutyrate measured at time of hypo and was negative.

What is 3-hydroxybutyrate?
1. End product of insulin metabolism
2. A free fatty acid
3. A triglyceride
4. A ketone body
5. A component of artificial nutrition

4. A ketone body

9

Case 2 - 1 day old neonate - jittery, not-feeding
Premature – 34 weeks gestation
Lab glucose 1.9 mmol/L
Glucose improved on feeding, but low blood glucose 4 hours after feed.
3-hydroxybutyrate measured at time of hypo and was negative.

whats absence of ketones signify?
1. Insulin deficiency
2. Fatty acid oxidation defect
3. Starvation

2. Fatty acid oxidation defect

10

CASE 4 -45-year-old lady admitted fitting. Recurrently seen GP in previous months due to weight gain and increased appetite
Husband reports personality change in last few months.
Glucose 1.9 mmol/L
Insulin 35 mu/L
C-peptide 1000 pmol/L

Whats diagnosis?
1. Insulinoma
2. Cushings syndrome
3. Addison’s disease
4. Sulphonylurea excess
5. Need more information

5. Need more information

11

Case 5 60 year old cachectic man found unconscious
Smoker
Glucose 1.9 mmol/L
Hypoglycaemia persists – glucose infusion
Insulin and C-peptide undetectable
Free fatty acids – undetectable
Ketones negative

Diagnosis?
1. Benign insulinoma
2. Non-islet cell tumour hypoglycaemia
3. Malignant insulinoma
4. Addison’s disease
5. Panhypopituitarism

2. Non-islet cell tumour hypoglycaemia