Endocrine Flashcards
(13 cards)
What are the clinical definitions for Hyperglycemia - 2
- Fasting BG > 90-130
- Postprandial BG > 180
What is DKA? ; Demographic?
state of absolute insulin deficiency, hyperglycemia, AG acidosis and dehydration
T1DM, younger
What are some of the main precipitants of DKA or HHS - 8
- Infections
- insulin therapy disruption
- Dietary indiscretion
- new onset
- Cocaine
- MI
- Surgery
- Trauma
What is Hyperosmolar Hyperglycemic State? ; Demographic?
state of hyperglycemia –> hyperosmolarity and dehydration without significant ketoacidosis
T2DM, older
What is the blood glucose threshold for obtaining UA to look for presence of ketones? ; What’s next step if UA does show ketones?
> 300 ; Get BMP to r/o AG metabolic acidosis
these pts will need IV saline
What is the blood glucose threshold for pts to start having sx of hyperglycemia?
> 180
Polyuria, Polydipsia, Polyphagia, Wt loss
What’s the basic workup for suspected DKA or HHS?
- CMP (including Phos and Mg)
- CBC
- Blood gas
- EKG (K+ shifts occur with marked acidemia or hyperglycemia)
Compare values between DKA and HHS in the following categories:
Plasma Glucose
pH
Ketones (Urine and Serum)
Anion Gap
Mental Status
Remember that HHS can present with both AG and ketosis but pH is usually normal
Tx for DKA and HHS is centered around evaluating Fluids, Insulin, K+, other disease process
What is tx plan for Fluids - 4
DKA: 1L/hr NS x 3-6
HHS: 1l/hr NS x 8-10
Switch to 1/2 NS when Na+ normalizes
Add Dextrose when BG reaches 250
Tx for DKA and HHS is centered around evaluating Fluids, Insulin, K+, other disease process
What is tx plan for Insulin replacement - 4
- regular insulin 0.1U/kg/hr and double dose if BG does not ⬇︎by 50-70 within 1st hour
- start this AFTER Fluid resuscitation
Tx for DKA and HHS is centered around evaluating Fluids, Insulin, K+, other disease process
What is tx rule for K+ replacement - 4
if initial K+ is < 3.3 then DELAY INSULIN until fluid and K+ replacement
Tx for DKA and HHS is centered around evaluating Fluids, Insulin, K+, other disease process
Is it ok to use HCO3 in pts with DKA? ; When is it optimal to use it? - 4
controversial considering it can –> paradoxical fall in cerebral pH –> neuro deterioration
- Severe acidosis < 6.9
- Severe life-threatening hyperKalemia
- Seizures
- Cardiac or persistently hypotensive pt
What’s one neurological complication of DKA/HHS
Cerebral Edema (occuring 4-12 hrs into tx with high degree of morbidity and mortality)
