Endocrine - Diabetes + Complications

Question 1

Definition - Alcoholic Ketoacidosis

Answer 1

Build up of ketones due to lack of insulin production due to excessive alcohol consumption

Question 2

Presentation - Alcoholic Ketoacidosis

Answer 2

Abdominal pain
Agitation
Confusion
Dehydration
Kussmaul’s breathing
N+V

Question 3

What is Kussmaul’s sign?

Answer 3

Irregular, deep and rapid breathing

Question 4

Diagnosis - Alcoholic Ketoacidosis

Answer 4

Blood ketones high
ABGs
Blood alcohol test

Question 5

ABG result - Alcoholic Ketoacidosis

Answer 5

Metabolic acidosis with a raised anion gap

Question 6

Management - Alcoholic Ketoacidosis

Answer 6

IV fluids (Saline + thiamine)
ICU admission often needed

Question 7

Complications - Alcoholic Ketoacidosis

Answer 7

Wernicke’s encephalopathy
Coma
Can be fatal

Question 8

Definition - Autonomic Neuropathy

Answer 8

Neuropathy affecting nerves that regulate internal functions

Question 9

Presentation - Autonomic Neuropathy

Answer 9

Changes in bowel habit
Dysphagia
Gastroparesis
Postural hypotension
Sweating
Tachycardia
Urinary issues

Question 10

Management - Autonomic Neuropathy

Answer 10

Symptomatic as required

Question 11

Definition - Charcot Arthropathy

Answer 11

A destructive inflammatory process causing bony destruction and deformity of the foot

Question 12

Causes - Charcot Arthropathy

Answer 12

Alcoholism
Diabetes
Leprosy
Syphillis

Question 13

Presentation - Charcot Arthropathy

Answer 13

Hot, swollen, red foot
Severe foot + ankle deformities

Question 14

Diagnosis - Charcot Arthropathy

Answer 14

MRI

Question 15

Management - Charcot Arthropathy

Answer 15

Total contact cast or air boot to stop weight bearing

Question 16

Complications - Charcot Arthropathy

Answer 16

Serious, permanent deformities
Instability

Question 17

Phases - Charcot Arthropathy

Answer 17

Active destruction for 3 months
Healing phase for 4-8 months
Chronic phase for around 8 months

Question 18

Definition - DKA

Answer 18

A state of uncontrolled catabolism in which ketone bodies are formed

Question 19

Most common precipitants - DKA

Answer 19

Infection
Missed insulin doses
MI

Question 20

Causes of increased insulin demand

Answer 20

The “5 I’s” = infections, inflammation, intoxication, infarction, iatrogenic

Question 21

Presentation - DKA

Answer 21

Abdominal pain
Altered conscious level
SOOB
Confusion
Fatigue
Polyuria + polydipsia
N+V

Question 22

Diagnostic Criteria - DKA

Answer 22

Glucose >11 or known diabetes
pH <7.3
Bicarbonate <15mmol/L
Ketones >3mmol/L or urine ketones ++

Question 23

Management - DKA (FIG-PICK)

Answer 23

Fluids
Insulin infusion
Glucose monitorring
Potassium monitoring
Identify + treat triggers
Chart fluid balance
Ketone monitoring

Question 24

Insulin Dose - DKA

Answer 24

0.1 units/kg/hour

Question 25

Complications - DKA

Answer 25

ARDS Aspiration pneumonia Cardiac arrest Cerebral oedema Hypokalaemia

Question 26

Resolution Criteria - DKA

Answer 26

pH >7.3 Blood ketones <0.6mmol/L Bicarbonate >15mmol/L