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PCM IV Exam I > Endocrine CIS > Flashcards

Flashcards in Endocrine CIS Deck (32):
1

Deep rapid respirations associated with acidosis

Kussmaul respirations

2

Calculation of anion gap

Na - (Cl + HCO3)

3

MUDPILES mnemonic for HAGMA

Methanol
Uremia (kidney failure)
Diabetic ketoacidosis
Paraldehyde/propylene glycol
Infection/iron/isoniazid
Lactic acidosis
Ethylene glycol
Salycylates

4

GOLDMARK mnemonic for HAGMA

Glycols (ethylene, propylene)
Oxoproline (metabolite of paracetamol)
Lactate/lactic acidosis
D-lactate (GI disorders)
Methanol
Aspirin
Renal failure
Ketoacidosis (starvation/ETOH/DKA)

5

DDx for diffuse abdominal pain — GI considerations

GERD +/- hiatal hernia

Gastritis

PUD

Small or large bowel obstruction

Inflammaton (ileitis, colitis, appendicitis, pancreatitis, cholecystitis)

Infectious: viral, bacterial, fungal, parasitic

Vascular, mesenteric thrombosis

6

DDx for diffuse abdominal pain — GU considerations

Renal lithiasis

Blocked or torsed ureter, testicular torsion

7

DDx for diffuse abdominal pain — toxic causes

Black widow spider bite
Snake bite

8

DDx for diffuse abdominal pain — metabolic considerations

Uremia

Hyperlipidemia (significantly elevated triglycerides can cause a pancreatitis)

DKA (note kussmaul breathing, unintentional weight loss, polyuria, polydipsia, polyphagia, hyperglycemia, positive ketones in urine and blood, low pH with anion gap)

9

Most common cause of hypoglycemia

Medications — exogenous insulin, sulfonylurea and meglatinides, alcohol

10

Besides medications, what are some causes of hypoglycemia to include in the DDx?

Critical illness — organ failure (hepatic, cardiac, renal); sepsis (hypermetabolic state)

Rarely hormone deficiency (cortisol, glucagon, epinephrine); endogenous hyperinsulinism (insulinoma, functional beta-cell disorder, etc)

11

Where should you admit a pt with DKA or hypoglycemia?

ICU — where they will get one-on-one nursing, continuous cardiac monitoring, and frequent lab evaluation

12

What is the most important treatment for DKA?

DKA requires high volume IV fluids

Initially normal saline, switch to D51/2 NS when pt on insulin gtt when their glucose gets to 250 to prevent hypoglycemia

13

Besides administering high volume IV fluids, what are other important points of treatment for DKA?

Electrolyte replacement (potassium, even if initially elevated — because insulin/IVF pH correction will drive K into cells and they usually become hypokalemic)

Frequent vital and lab monitoring (electrolytes need replacement — K, Mg, Ph-); check if AG is closing

Correct sodium when sugar is high (Na + [(glucose - 100) x 0.016]

Insulin gtt

14

Overall goal of treatment for DKA

Fix acid-base disturbance, NOT to bring sugar to normal level!

They can have a “normal” sugar and still have an anion gap acidosis, they will go right back into DKA if you stop tx too soon

15

When can you end DKA treatment protocol?

When anion gap is closed — then switch to subcutaneous insulin, stop gtt 2 hrs after administration of SQ long acting (they will go right back into DKA if you stop too soon)

16

Symptoms of hypoglycemia

Weakness or shakiness

Sweating

Altered mental status

Seizure

17

Treatment of hypoglycemia if pt is awake and alert

Fast acting carbs such as oral glucose tablet, hard candy etc.

18

Treatment of hypoglycemia if pt exhibits decreased level of consciousness or seizure

IV D50, glucagon IM

19

Anterior chapmans point for pancreas

R 7th ICS

20

Sympathetics and parasympathetics associated with pancreas

Sympathetics: T5-10

Parasympathetics: OA, AA

21

Sympathetics and parasympathetics associated with kidneys

Sympathetics: T10-L2

Parasympathetics: OA, AA

22

Anterior kidney chapmans points

1” superior and 1” lateral to umbilicus

23

Lymphatic OMT considerations for DKA pt

CV4 or condylar decompression to promote lymphatic flow and restore CRI (could be used for pts with complications of cerebral edema s/o DKA)

Pts with DKA may exhibit Kussmaul breathing, which can lead to rib and diaphragmatic dysfunctions — tx diaphragm and ribs

Make sure pt can handle return of fluid from 3rd spacing. If pt has heart failure or kidney problems, do not be as aggressive with treatment. If DKA was the result of infection, avoid lymphatics until infection is controlled

24

______________ drains right head and neck, right UE, all lung lobes except upper left

Right lymphatic duct

25

Treatment order for lymphatics

Thoracic inlet
Thoracic area
Abdominal area
UE or LE
Head and neck
Thoracic inlet

26

VINDICATE mnemonic for coming up with a DDx

Vascular
Infection, inflammation
Neoplasm
Drugs (toxins)
Iatrogenic, idiopathic
Congenital
Autoimmune, allergic
Trauma
Endocrine/metabolic/environmental

27

What is Whipples triad?

1. Symptoms potentially explained by hypoglycemia

2. Low blood glucose during symptoms

3. Relief of symptoms with administration of glucose or glucagon

28

Effects of regular IV insulin on DKA in terms of hepatic glucose output, glucose utilization, and lipogenesis

Decreased hepatic glucose output

Increased glucose utilization (increased GLUT4 cell membrane translocation in muscle and adipose)

Increased lipogenesis (decreases ketonemia, blood pH normalization)

29

Second generation sulfonylurea that blocks K(ATP) channel and is not considered a euglycemic drug

Glyburide

30

Drug interaction of glyburide + naproxen

Enhanced hypoglycemia — both glyburide and naproxen are highly plasma albumin bound (over 99%); adding naproxen will increase free glyburide levels

31

Drug interaction of glyburide + alcohol

Enhanced hypoglycemia — ethanol enhances the effect of glyburide on K(ATP) channel; ethanol suppresses gluconeogenesis by depleting gluconeogenic substrates, pyruvate and oxaloacetate

32

2 options for treating glyburide-induced hypoglycemia

Octreotide (50-150 mcg SC or IM q6-8h x24h) = DRUG OF CHOICE in glyburide-induced hypoglycemia

Glucagon (1 mg SC or IM)

[glucagon may not be a good choice — very short acting, may not be effective in cases of prolonged hypoglycemia when hepatic stores of glycogen are depleted]