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SU-18 ER > Endocrine > Flashcards

Endocrine Flashcards

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1
Q

previously diagnosed type 1 DM

A

est. based on hyperglycemia on multiple ED visits

refer to PCP for insulin dose adjustment

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2
Q

tx of persistent hyperglycemia in T1DM

A

blood surgery level diary

every dose of insulin administered and type administered

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3
Q

undiagnosed diabetic ER

A

ER doc makes diagnosis with pt who fits criteria

confirmatory test needed and review of medical hx

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4
Q

tx of undiagnosed diabetic in ER (stable)

A

12-24 hr f/u with PCP

if this is not possible, admit to tele

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5
Q

t1DM and glucocorticoid

A

develop hyperglycemia due to steroid tx

warning signs of hyperglycemia, seek close follow up with PCP and monitor glucose free.

add additional prandial doses of insulin )no need to increase basal insulin)

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6
Q

false glucose reading

A

icodextrin (peritoneal hemodialysis)

increased blood glucose levels with BEDSIDE reading

central lab glucose readings should be the ones that govern management

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7
Q

hypoglycemia value

A

plasma glucose <50 mg/dL

common in diabetics due to no surge of glucagon

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8
Q

hypoglycemia blunting 2/2

A

age
BB
neuorpathy
repeat episode = autonomic dysfunction

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9
Q

evaluation of hypoglycemia

A

history and physical

emphasis on timing and administration of insulin relation to meals

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10
Q

common causes of hypoglycemia

A 
inadequate food intake 
infection 
change to regimine 
OD of medication or insulin 
BB toxicity 
renal failure 
ACS 
stress
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11
Q

s.s of hypoglycemia

A

drowsy, confused, dizzy, tired, cant concentrate or speak

tremor, sweating, anxiety, nausea, palpitations, shivering

hunger, weakness, blurred vision

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12
Q

alert pt hypoglycemia tx

A

glucose containing carbs

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13
Q

unconscious pt hypoglycemia tx

A

Glucagon 1 mg IV, IM, SC

1 amp of D50 IV

then pt consumes meal or snack

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14
Q

glucagon emergency kit

A

T1DM family members carry for hypoglycemia

1 mg IM glucagon – 10-15 minutes onset then swallow oral glucose

can cause n/v

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15
Q

hypoglycemia discostino

A

not on long acting - discharged

on long acting - admitted for monitoring

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16
Q

DKA epidemiology

A

mc in insulin dependent DM (T1)

higher mortality in elderly and in coma or HoTN

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17
Q

patho of DKA

A

cellular starvation 2/2 insulin deficiency and counter regulatory hormone excess

causes hyperglycemia, osmotic diuresis, preernal azotemia, ketone formation, wide anion gap metabolic acidosis

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18
Q

insulin fxn

A

metabolism and storage of carbohydrates , fat, protein

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19
Q

counter regulatory insulin hormones (4)

A

glucagon
catecholamines
cortisol
growth hormone

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20
Q

hyperglycemia in DKA

A

due to excess production and underutilization of glucose

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21
Q

counter regulatory hormones DKA cause

A

MC Glucagon

increased gluconeogenesis
breakdown of fats into free fatty acid and glycerol
proteolysis with increased amino acid level

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22
Q

lipolysis in DKA

A

free fatty acids that are released are broken down to ketone bodies and cause a metabolic acidosis

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23
Q

osmotic diuresis in DKA

A

caused by persistently elevated glucose

causes volume depletion and worsened hyperglycemia and increased ketones

this activates RAAS

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24
Q

vasodilation in DKA

A

despite volume depletion, prostaglandin activation is caused by adipose tissue breakdown

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25
causes of DKA
``` reduced/skipped insulin injection infection pegnancy hyperthyroidism substance abuse or medication heat CVA GI hemorrhage MI PE trauma or surgery ```
26
clinical manifestations of DKA due to
hyperglycemia volume depletion adcidosis
27
clinical features DKA
``` polyuria, polydipsia increased ventilation HoTN weakness AMS ``` poor turgor, fruity odor on breath, abdominal pain
28
ventilation DKA
increased to try to counteract the metabolic acidosis kussmaul respiration (increased rate and depth)
29
MC presenting symptoms of DKA
tachycardia HoTN these are due to volume depletion
30
main priority in DKA tx
give NS 1L IV bolus
31
w.u. of DKA
``` accucheck UA BMP 12 lead EKG VBG ```
32
DKA lab findings
serum glucose >250 anion gap >12 bicarb <15 pH <7.3
33
hyperkalemia and DKA
due to extracellular shift of K (acidosis) increased osmolarity due to hyperglycemia if <3.3 -- insulin therapy should not be started until K is managed insulin will put K back in cell (dysrythma)
34
ketones in DKA (3)
B-hydroxybutyrate aceoacetic acid acetone
35
priorities of DKA tx
1. volume first 2. correction of K if needed 3. insulin administration
36
fluid administration DKA
fluids help increase volume and electrolytes and dilute glucose and ketone levels 1 L administered in first 30 (2L administered over 0-2 hrs) NEXT: 2 L over 2-6 hrs and 2L more over 6-12 hrs (total 6 L in 6-12 hrs)
37
if blood glucose is 250 mEq, fluid admin...
5% dextrose in 0.45 NS + 20mEq KCL/L at infusion rate of 250 mL/hr thru second IV line
38
Potassium and DKA
pts in DKA have potassium DEFECIT but the lab results are high if initial K is 3.3 or lower (low) then the pt is severely depleted and must replace life threatening derangement
39
goals of K replacement DKA
maintain normal ECF K during acute therapy and replace the cell deficit in 24 hrs if deleted rapidly -- cardiac arrhythmia, respiratory paralysis, ileus, rhabdo
40
DKA tx may cause K to fall bc
insulin promotes reentry into cell dilution of ECF acidosis correction
41
K correction in DKA | serum: >5.3
IV insulin drip with NO supplemental potassium
42
K correction in DKA | serum: 3.3-4.0
IV insulin drip | IV of 0.45 NS + KCL 40 mq/L at 250 mL/h
43
K correction in DKA | serum: 4.0-5.3
IV insulin drop | IV 2 of 0.45 NS + KCL 20 mEq/L
44
K correction in DKA | serum: <3.3
HOLD insulin | 0.45 NS at 250 mL/h + 60 mEq/L until K >3.3
45
insulin drip in DKA
following 1 L of NS and K correction can start low dose regular insulin drip 0.1 u.kg.hr once starting to infuse, concentration decreases 50 mg/dL.h stop once ketonemia and anion gap gone
46
insulin loading dose in DKA
can be give in adults but NOT IN PEDS (can cause cerebral edema and death)
47
acute complications of DKA
sepsis loss of airway MI hypovolemic schok
48
DKA complications related to tx
``` hypoK hypophosphatemia ARDS cerebral edema hypoglycemia ```
49
late DKA complications
recurrent anion gap metabolic acidosis non anion gap acidosis vascular thrombosis fungal infection
50
DKA and pregnancy
triggered at lower serum glucose levels pregos have more vomiting and UTI --> triggers of DKA leading cause of fetal loss (30% mortality)
51
DKA prego patho
mom hyperglycemia - fetal hyperglycemia and death maternal acidosis = fetal acidosis, decreased blood flow and oxygenation maternal hypoK = arrhythmia in fetus and death
52
pt population most likely to get HHS
debilitated pt with poorly controlled T2DM or undiagnosed T2DM
53
HHS precipitated by
limited access to water | medical event/stressor
54
development of HHS is attributed to 3 main factors
1. insulin resistance and/or deficiency 2. increased hepatic gluconeogenesis and glyconeolysis 3. osmotic diuresis and dehydration
55
HHS patho
increased serum glucose causes water in vascular space and GFR increase kidneys unable to reabsorb glucose = osmotic diuresis pt is unable to replace fluid loss = water deficit and profound volume depletion
56
history of HHS
elderly w/comorbidities start to develop mental status changes
57
medical conditions that predispose a patient to HHS
PNA UTI non compliance with DM meds PE, hear related illness, mesenteric ischemia, MI, burn, renal, CVA, rhabdo
58
diagnosis of HHS
severe hyperglycemia (>600 mg glucose) with negative ketones elevated osmolality of >315 mOSM/kg arterial pH > 7.3
59
serum osmolality in HSM
>300 (>320- lethargy)
60
HHS tx
correction of hypovolemia ID and tx precipitating causes correction of electrolyte abnormalities, hyperglycemia, osmolarity
61
complications of HHS
cerebral edema UNCOMMON limit volume rate to <50 ml/kg in first 4 hrs potential for hypoglycemia, hypokalemia and pulmonary edema if rapid fluid admin
62
alcoholic ketoacidosis
acute cessation of alcohol consumption after chronic abuse N/V and GI complaints drinking + vomiting then decreased food and alcohol changes
63
alcoholic ketoacidosis s/s
tachycardia, tachypnea, abdominal tenderness | n/v, abdominal pain
64
diagnostic criteria for alcoholic ketoacidosis
``` serum glucose low-slight elevated binge drinking ending in n/v/decreased intake wide anion gap metabolic acidosis positive serum ketone wide anion gap metabolic acidosis ```
65
tx of alcoholic ketoacidosis
hydration (5% dextrose) carbohydrates to reverse ketoacitosis (increase insulin and suppress glucagon release) thiamine supplementation replace electrolytes

SU-18 ER (11 decks)

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