Endocrinology handbook Flashcards
What is the diagnostic criteria for diabetic ketoacidosis?
Plasma glucose >14mmol/L
Arterial pH <7.3
Plasma HCO3- <15mmol
High anion gap and moderate ketonuria or ketonemia (or high serum BHBA)
What are the investigations for diabetic ketoacidosis in the initial hour?
Urine & Blood glucose Urine + plasma ketones or BAHA
Na, K, PO4, Mg, Anion gap (AG)
Urea, Creatinine, Hb Arterial blood gas (ABG)
If indicated:
CXR, ECG
Blood & urine culture and
sensitivity
Urine & serum osmolality PT, APTT
What are the Ix for DKA to keep monitoring after the initial hour?
Hourly urine and blood glucose
Na, K, urea, AG (till blood glucose <14 mmol/L)
Repeat ABG if indicated
(intensive monitoring of electrolytes
and acid/base is crucial in the first 24-48 hours)
What is the parameters to be monitored in DKA?
Hourly BP/pulse, respiratory rate, conscious level, urine output, central venous pressure (CVP)
2-hourly temperature
What is the management of patient with diabetic ketoacidosis in the inital hour and susbequent hours?
What is the management for thyroid storm patient?
- Close monitoring: often need CVP, Swan Ganz, cardiac monitor, ICU care if possible
- Hyperthermia: paracetamol, physical cooling> dehydration: IV fluid, glucose, vitamin (thiamine)
- Propylthiouracil, hydrocortisone, B blockers (exclude asthma): propranolol. If B blockers are contraindicated, consider diltiazem
- 1 hour later, use iodide to block hormone release: 6-8 drops Lugols solution
- Consider Li2Co3 250mg q6h to achieve Li level 0.6-1.0mmol/L
- Consider plasmapharesis adn charcoal haemoperfusion for desperate cases
What is classical presentation of phaeochromocytoma?
What is the ix?
What is management and drugs used?
Presentation: classical triad of headache, sweating and tachcyardia; young/severe/resistant hypertension, adrenal incidentaloma
Biochemical confirmation by measuring urine catecholamines, fractionated metanephrines and normetanephrines
Preoperative localization and staging by anatomical and functional scan
Alpha blokcers: phenoxybenzamine, prazosin, doxazosin
What is the possible pattern of presentation for post traumatic diabetes insipidus?
Phase 1: transient DI, duration hours to days
Phase 2: antiduresis, duration 2-14 days
Phase 3: return of DI (may be permanent)
What to monitor in acute post op/post trauma diabetes insipidus?
What is the management of post traumatic DI?
- Monitor I/O, BW, serum sodium and urine osmolarity closely (q4h initially, then daily)
* Able to drink, thirst sensation intact and fully consious: oral hydration, allow patient to drink as thirst dictates)
* Impaired consiousness and thirst sensation
Fluid replacement as D5 or 1/2:1/2 solution
DDAVP 1-4mg (0.5-1ml) q12-24 hr sc/iv. Allow some polyuria to return before next dose. Give each successive dose only if urine volume >200ml/hr in successive hours
Stable cases
Give oral DDAVP 100-200mg BD to TDS or 60-120mg BD to TDS to maintain urine output of 1-2L/day
What is the diagnostic criteria for diabetic hyperosmolar hyperglycemic states?
What is the management principles?
What is the preop management of DM patients?
What is the management of DM patients on the day of operation for major surgery?
What is the management of DM patients on the day of operation for minor surgery?
What is the management of DM patients post op care?
What is insulin therapy for type 2DM?
What is insulin therapy for type 1DM?
What are the tests for hypoglycemia?
What is treatment?
How to manage myxoedema coma?
Ix for addisonian crisis
Tx for suspected addisonian crisis?
Relative potencies of different steroids?
Indications for steroid cover for surgery/trauma?
