Kirila CIS Endocrine Pancreas Flashcards
(36 cards)
basal vs bolus insulin
basal is long acing insulin to achieve more steady state of glucose control
bolus insulin can be adjusted at mealtime and based on FSG
different terms for hemoglobin A1c
HbA1c
GHbA1c
glycosylated hemoglobin
how to measure HbA1c
typically on venipuncture sample, also fingerstick machines available
possible presentations to include DM in DD
mental status changes
abdominal pain
dehyrdation
mental status changes
AEIOU TIPS
alcohol epilepsy with seizure activity infection overdose uremia
trauma
insulin (high or low blood sugar)
poisoning/psychosis
stroke
abdominal pain DD
BAD GUT PAINS
bowel obstruction
appendicitis, adenitis
diverticulitis/DKA/dysentary/ diarrhea drug withdrawal
Gatroenteritis/GB disease/stones/obstruction/infection
Urinary tract obstruction or infection
Testicular Torsion
Toxin- lead, black widow spider bite
Pneumonia/pleurisy/pancreatitis/perforated bowel/ulcer/porphyuria
Abdominal aneurysm
IN- infarcted bowel
S splenic rupture/infarction/ sickle cell pain crisis
non-ketotoic hyperosmolar state seen more in
DM 2
etiology of DKA
inadequate insulin administration infection: pneumonia, UTI, gastroenteritis, sepsis infarction- any location surgery drugs (cocaine)
iii suk D
initial symptoms of DKA
VAN TP
vomiting
Anorexia
nausea
thirst
polyuria
DKA hyper or hypotension
tachy or brady cardia
hypotension and tachy
high anion GAP acidosis
MUD PILES
Methanol
Uremia
DKA
Paraldehyde Isopropyl alcohol, iron, INH Lactic Acidosis Ethylene Glycol Salicylates
sodium in DKA
measured sodium is low secondary to hyperglycemia (water pulled into ECF bc hyperosmolar)
for every 100 mg/dL that glucose is over 100mg/dL there will be a 1.6 reduction in sodium
labs DKA potassium TGs lipids and proteins amylase WBC
serum may be normal or somewhat high
-actually total body deficit
hyperTGs
hyperlipoproteinemia
hyperamylasemia
-can suggest acute pancreatitis
leukocytosis
treatment of DKA
frequent monitoing of gen status, vital signs, glucose and
A-B status
renal function
K+ and electrolytes
fluid replacement in DKA
2-3 L NS over first 1-3 hours (5-10 ml/kg/hr)
then 1/2 strength saline at 150 ml/hr
when glucose reaches 250 switch to D51/2 NS at 100-200 ml/hr
fluid deficit is often 3-5 L
initial insulin admin DKA
regular insulin
10-20 units UV or IM (0.15/kg)
then: 5-10 units/hr continous IV or (0.05=.1/kg/hr)
increase if no response in 1-2 hours
DKA eval for underlying causes
cultures EKG CXR drug scren seek additional family history
initial montioring in DKA
BSG hourly
clinical status hourly
-vitals, mental status, fluid I & O
potassium replacement in DKA
consider potassium replacement when serum K is under
5.5 meq/L
when supplemnting potassium keep what in mind
renal function
EKG and cardiac monitoring
verify urinary output and measure hourly
-likely will need indwelling foley catheter initially
glucose goal of DKA (level)
150-250
when do you start intermediate of long acting insulin
when pt is able to eat when
-mental status improved, no nausea/vomiting, no ab pain
anion gap normalized
allow overlap timing of IV with SQ insulin usually by 30-60 mintues
etiology of NKHS
insulin deficiency
inadequate fluid intake
osmotic diuresis induced by hyperglycemia
sepsis MI glucocorticoids phenytoin thiazide diuretics no water access
symptoms of NKHS
polyuria
alterd mental state
thirst
(PAT)
no nausea, vomiting, ab pain, and kussmaul resp
