Endocrine Flashcards
Name the features that suggest severe DKA
- Blood ketones > 6mmol/l
- Bicarbonate < 5mmol/l
- Blood pH <7.1
- Hypokalaemia
- GCS <12
- Sats <92%
- Systolic BP <90mmHg
- Tachycardia or bradycardia
Describe the management of DKA
Hour 1: 1L 0.9% saline and Actrapid
Hour 2: 1L 0.9% saline and continue actrapid while BG>14
Hour 3: 500ml 0.9% saline +/- KCl
Hours 4-discharge: reduce rate of saline and restart s/c regime when eating and drinking
Name the potential complications of DKA
- Hyper and hypokalaemia
- Hypoglycaemia
- Rebound ketosis
- Arrhythmias
- Acute brain injury
- Cerebral oedema
- Aspiration pneumonia
- Arterial and venous thromboembolism
- ARDS
How does diabetic retinopathy present?
- Non-proliferative: retinal capillary dysfunction, platelet dysfunction and blood viscosity abnormality
- Proliferative: retinal ischaemia, new blood vessel formation, vitreous haemorrhage and retinal tears/detachment
How does hyperosmolar hyperglycaemic state present?
- Usually T2DM
- Osmolality >320mOsm/kg
- Hyperglycaemia > 30mmol/l
What causes HHS?
- Inadequate insulin/non-compliance
- Acute illness
- Endocrine
- Drugs: B-blockers, anti-psychotics, steroids and immunosuppressants
How is HHS managed?
- IV fluids
- IV insulin
- IV potassium
- Gradual treatment
- Treat underlying causes
Name the options for managing hypoglycaemia
- 15-20g quick acting carbohydrates
- 1.5-2 tubes of glucogel
- 1mg Glucagon IM
- IV glucose: 75ml 20% or 150ml 10% glucose
How can type 2 diabetes be managed?
- 1st line: metformin or sulfonylurea
- 2nd line: Thiazolidinedione, DPP-IV inhibitor or SGLT-2 inhibitor
- 3rd line: any of the 2nd line agents + GLP-1 agonist or insulin
Give two examples of sulfonylureas
- Glimepiride
- Gliclazide
Give an example of a thiazolidinedione
Pioglitazone
Give an example of a DPP-IV inhibitor
Sitagliptan
Give an example of a SGLT-2 inhibitor
Empagliflozin
Give an example of a GLP-1 agonist
Lixisenatide
Name some of the side effects of metformin
- Lactic acidosis
- Nephrotoxic
- GI side effects
Name some of the side effects of sulphonylureas
- Hypoglycaemia
- Weight gain
- Blood disorders
Name some of the side effects of thiazolidinediones
- Fluid retention
- Weight gain
- Fractures in females
Name some of the side effects of DPP-IV inhibitors
- Headaches
- Changes in bowel movements
- Gallstones
- Pancreatitis
Name some of the side effects of GLP-1 agonists
- Acute pancreatitis
- Nausea and vomiting
- Renal impairment
- Atrioventricular block
Name some of the side effects of SGLT-2 inhibitors
- UTIs
- URTI
- Increased urination
- Dyslipidaemia
- Genital yeast infections
At which HbA1c level should you consider adding another diabetes drug?
58mmol
Describe the TFT results for primary hypothyroidism
- Raised TSH
- Low T4
- Compensated: raised TSH and normal T4
Describe the TFT results for secondary hypothyroidism
- Low TSH
- Low T4
How would a solitary thyroid nodule be investigated?
- TFTs
- USS
- FNA
