exam 1 hyperglycemic crises pp

Question 1

DKA more seen in

Answer 1

T1DM
younger ppl
recurrent in hospitalized pts

Question 2

HHS more seen in

Answer 2

T2DM
higher mortality rate than DKA
older ppl

Question 3

DKA can present in T2DM when

Answer 3

under stress
pts taking SGLT2 that leads to euglycemic asymptomatic DKA

Question 4

T1DM risk factors DKA

Answer 4

younger age
history or hyperglycemia and hypoglycemic crises
kidney disease
neuropathy
depression
smoking
alcohol and drug use
high A1C and SDOH

Question 5

T2DM risk factors DKA

Answer 5

younger age
history or hyperglycemia and hypoglycemic crises
comorbidities
elevated A1C and SDOH

Question 6

socioeconomic risk factors DKA

Answer 6

low income
area level deprivation
housing insecurity
lack of insurance or underinsured
food insecurity

SDOH
mental health conditions

Question 7

precipitating factors for DKA

Answer 7

omission or insufficient use of insulin
infections
alcohol or drug use
PE
MI
stroke
pancreatitis
trauma

Question 8

precipitating factors for HHS

Answer 8

infection
acute CV events
MI
surgery
acute pancreatitis
heat stroke

Question 9

drugs that can precipitate DKA and HHS

Answer 9

phenytoin
clozapine
olanzapine
calcineurin inhibitors
glucocorticoids
cimetidine
SGLT2
thiazides
cocaine

Question 10

absolute or relative insulin deficiency
elevation of counter regulatory hormones (glucagon, EPI, NE, cortisol, growth hormone)

Answer 10

DKA

Question 11

DKA presentation

Answer 11

hyperglycemic
volume depletion (dehydrated)- decreased urine output, dry mouth, polyuria, polydipsia
N/V
abdominal pain

Question 12

DKA diagnosis criteria
glucose
ketosis
metabolic acidosis

Answer 12

> 200
3
pH <7.3 OR bicarb <18

Question 13

mild DKA acidosis

Answer 13

pH 7.25-7.3
bicarb 15-18

Question 14

moderate DKA acidosis

Answer 14

pH 7-7.25
bicarb 10-15

Question 15

severe DKA acidosis

Answer 15

pH,7
bicarb<10

Question 16

decreased pH
decreased serum bicarb

Answer 16

metabolic acidosis

Question 17

metabolic acidosis respiratory compensation

Answer 17

Kussmaul respirations:
rapid breathing
fruity breath

Question 18

anion gap equation

Answer 18

Na-Cl-HCO3
>12 is consistent with metabolic acidosis

Question 19

IV fluids used

Answer 19

0.9% NS
LR

Question 20

when glucose reaches <250 what should be added

Answer 20

5 or 10% dextrose

Question 21

euglycemic DKA needs what fluids when starting insulin

Answer 21

0.9% NS OR LR AND
5 OR 10% dextrose

Question 22

mild DKA insulin therapy

Answer 22

rapid insulin SC
0.1 units/kg bolus then every hour
when glucose reaches <250 insulin 0.05 units/kg/hr

Question 23

moderate-severe DKA insulin therapy

Answer 23

short acting insulin IV
0.1 units/kg bolus then 0.1 units/kg/hr infusion
when glucose reaches <250 insulin 0.05 units/kg/hr

Question 24

DKA target glucose

Answer 24

<200

Question 25

in DKA and metabolic acidosis potassium shifts which way

Answer 25

intracellular to extracellular

Question 26

what decreases potassium with DKA

Answer 26

insulin correction of acidosis volume expansion increased kaliuresis

Question 27

potassium decreases by how much in what amount of time after admitted

Answer 27

decreases 1-2 in 48hrs

Question 28

potassium replacement when

Answer 28

<5 with a goal to maintain 4-5

Question 29

K<3.5 give

Answer 29

10-20mmol until K>3.5 delay insulin until >3.5

Question 30

K 3.5-5 give

Answer 30

5mmol 10-20mmol to maintain 4-5

Question 31

K>5

Answer 31

start insulin and don't give K check K every 2hr

Question 32

only give bicarb when

Answer 32

pH<7 8.4% every 2hr until pH>7

Question 33

only give phosphate when

Answer 33

muscle weakness (respiratory or cardiac compromise) and phosphate <1

Question 34

glucose levels <200 in the presence of ketosis and metabolic acidosis

Answer 34

euglycemic DKA

Question 35

euglycemic DKA caused by

Answer 35

exogenous insulin injection reduced food intake pregnancy impaired gluconeogensis (alcohol use, liver failure, SGLT2)

Question 36

euglycemic DKA risk factors

Answer 36

fasting or low carb diet surgery infection adjustments to insulin

Question 37

euglycemic DKA symptoms

Answer 37

do not present with hyperglycemia fruity breath nausea SOB fatigue

Question 38

why don't we use SGLT2 in T1DM

Answer 38

risk of euglycemic DKA

Question 39

HHS diagnostic criteria glucose serum osmolality ketonuria acidosis

Answer 39

>600 >300 <3 pH >7.3 bicarb >15

Question 40

HHS characterization

Answer 40

sever hyperglycemia hyperosmolality dehydration in absence of significant ketosis or acidosis residual amount of insulin secretion that minimizes ketosis

Question 41

HHS insulin

Answer 41

0.05 units/kg/hr short acting fixed rate infusion

Question 42

HHS goal glucose serum osmolality

Answer 42

200-250 <300

Question 43

mixed DKA and HHS insulin

Answer 43

0.1 units/kg/hr

Question 44

hyperglycemia in hospitalized pts

Answer 44

>140

Question 45

hypoglycemia level 1-3

Answer 45

1- BG 54-69 2- BG <54 3- altered mental status or physical functioning 2 and 3 need immediate intervention

Question 46

ICU pt hyperglycemia target

Answer 46

>180 on 2 occasions within 24hr 140-180

Question 47

not in ICU hyperglycemia target

Answer 47

>180 on 2 occasions within 24hr 100-180

Question 48

pt in hospital eating should have BG checked when

Answer 48

before every meal

Question 49

pt in hospital NPO should have BG checked when

Answer 49

every 4-6hr

Question 50

pts receiving IV insulin should have BG checked when

Answer 50

30min-2hr

Question 51

what should be started on pts in hospital with T2DM and HF

Answer 51

SGLT2

Question 52

which med has increased risk of metabolic acidosis

Answer 52

metformin