Ketoacidosis Flashcards Preview

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Flashcards in Ketoacidosis Deck (17):
1

Rapid acting insulin

Lispro
Onset = 15-30 minutes
Peak = 30-90 minutes
Duration = 3-5 hrs

2

Long acting insulin

Glargine
Onset = 1-1.5 hrs
Duration = 24 hrs
NO PEAKS

3

Short acting

Regular
Onset = 30-60 min
Peak = 2-5 hrs
Duration = 5-8 hrs

4

Intermediate

NPH
Onset = 1-2 hrs
Peak = 4-12 hrs
Duration = 18-24 hrs

5

How does insulin effect menstrual cycle

Insulin stimulates gonadotropin hormone
- so, low insulin --> low gonadotropin hormone --> less FSH and LH --> dysregulation of menstrual period

6

Type 1 diabetes genetics

HLA-DR3 and DR4 --> 90% of Caucasians with diabetes have those haplotypes
Type IV hypersensitivity --> T cell destruction of pancreatic beta cells --> low insulin --> hyperglycemia

7

Mechanism of Insulin

Insulin binds to its receptor (tyrosine kinase) → tyrosine phosphorylation of receptor → glycogen, lipid, and protein synthesis as well as increased expression of GLUT-4 receptor for glucose uptake into cells (adipose tissue and skeletal muscle)

8

K+ Homeostasis

High K+ --> increased ROMK and BK channels in Principal Cells, increased Na/K ATPase activity in all cells
Low K+ --> decreased ROMK and BK channels in Principal Cells, increased K/H ATPase in alpha-intercalated cells

9

Causes of moving K into cells

Hyperinsulinemia
Increased catecholamines
Metabolic alkalosis

10

Causes of moving K out of cells

Insulin deficiency
Metabolic acidosis

11

Tm of glucose

Tm is the maximum amount of glucose the kidney can reabsorb. Once the kidney reaches its maximum, glucose can't be reabsorbed any further because the channels are saturated --> glucosuria

12

Respiratory compensation of metabolic acidosis

Kussmaul respirations
rapid shallow breathing --> blow off CO2 --> shift equation toward CO2 and away from H+

13

Respiratory compensation of metabolic alkalosis

Hypoventilation
- decrease in breathing --> increase CO2 --> shift equation toward H+ and away from CO2

14

Most common precipitating factor of DKA

Not taking insulin

15

Stressors effects on precipitating DKA

Stressors cause release of Epi --> blocks insulin action and stimulates glucagon --> decrease utilization of glucose in periphery and increased gluconeogenesis --> severe hyperglycemia --> osmotic diuresis and dehydration

16

Clinical presentation of DKA

fatigue, N/V, abdominal pain, fruity odor breath, Kussmaul breathing --> all can lead to decrease cerebral perfusion and coma

17

2nd major effect of insulin deficiency

increased ketogenic machinery
- stimulate lipoprotein lipase --> increased fatty acid beta oxidation --> lots of ketone bodies --> too many for kidney (ketonemia, ketonuria) --> metabolic ketoacidosis