Endocrine 01 - Diabetes pt 3

Question 1

an acute state of severe uncontrolled diabetes that requires emergency treatment with insulin and intravenous fluids

Answer 1

Diabetic Ketoacidosis

Question 2

What’s normal blood pH?

Answer 2

7.4

Question 3

Define Diabetic Ketoacidosis

Answer 3

an acute state of severe uncontrolled diabetes that requires emergency treatment with insulin and intravenous fluids

Question 4

Biochemically, how is DKA (Diabetic Ketoacidosis) defined? (3)

Answer 4

serum ketone concentration: > 5 mEq/L
Blood glucose > 250
Low blood pH < 7.2

Question 5

Dehydration
Hyperglycemia
Acidosis
Ketonuria

Answer 5

DKA

Question 6

What does Potassium have to do with Diabetes and DKA? What may it lead to?

Answer 6

When you give insulin, Potassium goes into the cell -> they have low blood potassium.
If serum K is not monitored and replaced as needed, life-threatening hypokalemia may develop

Question 7

Difference btwn DKA and HHNK (3)

Answer 7

DKA occurs with the presence of ketosis while HHNK has no evidence of ketoacidosis.
DKA is commonly treated with insulin therapy while HHNK’s dehydration is the first thing that is treated together with attention to infection.
DKA have a fruity odor in the mouth due to ketone bodies, something that is not present in HHNK.

Question 8

Nausea/vomiting, Thirst/polyuria, Abdominal pain, Shortness of breath, Tachycardia, Dry mucous membranes/reduced skin turgor, Dehydration / hypotension/tachycardia, Tachypnea / Kussmaul respirations/respiratory distress (fruity breath), Abdominal tenderness (may resemble acute pancreatitis or surgical abdomen), Lethargy /obtundation / cerebral edema / possibly coma, Abdominal pain- particularly in childre,
Lethargy and somnolence - of more severe decompensation, In the absence of timely treatment progresses to coma and death

Answer 8

DKA

Question 9

Children with __ and __ at presentation appear to be at greatest risk of DKA.

Answer 9

high BUN (blood urea nitrogen)
lowest PaCo2

Question 10

4 essentials for diagnosis of DKA

Answer 10

Hyperglycemia >250mg/dl
Acidosis with blood pH <15 mEq/L
Serum positive for ketones

Question 11

If urine glucose and ketones are strongly positive, presume it is:

Answer 11

DKA

Question 12

Tx of DKA (besides ID’ing precipitating factors, and ICU lab assessments every hour)

Answer 12

Rapid intravascular volume repletion, correction of hyperglycemia and acidosis, and prevention of hypokalemia

Question 13

Management of Hyperglycemia

Answer 13

Administer regular insulin

Question 14

3 ways Diabetic Neuropathy may present:

Answer 14

Impaired sensation or pain in the feet or hands
Slowed digestion of food in the stomach
Carpal tunnel syndrome

Question 15

2 big Risk Factors for Diabetic Neuropathy (don’t think too hard)

Answer 15

glucose control and duration of diabetes (>25 years)

Question 16

4 types of Diabetic Neuropathy

Answer 16

Symmetric polyneuropathy
Autonomic neuropathy
Polyradiculopathy
Mononeuropathy

Question 17

Define Symmetric polyneuropathy

Answer 17

most common form of neuropathy seen in diabetic patients. Symptoms generally begin distally in the toes and feet and move upward toward the calf. It is not uncommon for symptoms to also begin to appear in the hands, and the patient develops what is known as “stocking-glove” sensory loss.
Symptoms include pain, abnormal sensation in the affected areas, and loss of vibratory sensation. Thermal sensation is also affected.

Question 18

Diabetic Neuropathy and its subtypes are all pretty much treated with: (3) (general goals)

Answer 18

Glucose control, treatment of pain, and foot care.

Question 19

Symmetric polyneuropathy commonly causes __ problems

Answer 19

foot problems. (ulcers, amputations)

Question 20

Acutely swollen foot with negative radiographic changes may represent the early stage of :

Answer 20

Charcot’s foot

Question 21

Define Autonomic neuropathy

Answer 21

Autonomic neuropathy can affect the limbs, the genitals and urinary tract, the gastrointestinal tract, or the heart. This form of neuropathy is classified as clinical or subclinical based on the presence or absence of symptoms.

Question 22

Contributes to the following symptoms/signs:
Neuropathic arthropathy (Charcot foot)
Aching, pulsation, tightness, cramping, dry skin, pruritus, edema, sweating abnormalities
Weakening of the bones in the foot leading to fractures

Answer 22

Peripheral Autonomic Dysfunction

Question 23

List 4 signs and symptoms of Genitourinary Autonomic Neuropathy, and the treatments for each 4.

Answer 23

Bladder dysfunction: tx- Voluntary urination, catheterization
Retrograde ejaculation - Antihistamine
Erectile dysfunction - Sildenafil, tadalafil
Dyspareunia (painful intercourse) - Lubricants

Question 24

____ can cause anorexia, nausea, vomiting, early satiety, and postprandial fullness.

Answer 24

Gastroparesis. Caused by Gastrointestinal Autonomic Neuropathy

Question 25

Exercise intolerance

Postural hypotension

Answer 25

Cardiovascular Autonomic Neuropathy

Question 26

Thigh pain followed by muscle weakness and atrophy

Answer 26

Polyradiculopathy (Lumbar polyradiculopathy is most common)

Question 27

Occurs in wrist (carpal tunnel syndrome), elbow, or foot (unilateral foot drop)
Symptoms/Signs
numbness, edema, pain, prickling

Answer 27

Peripheral mononeuropathy

Question 28

Symptoms/Signs
unilateral pain near the affected eye
paralysis of the eye muscle
double vision

Answer 28

Cranial Mononeuropathy

Question 29

The 2 types of Mononeuropathy are:

Answer 29

Peripheral mononeuropathy

Cranial Mononeuropathy