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Flashcards in Kirila DSA Deck (21)
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1

DM type 1- essentials of dx

-polyuria, polydipsia, and weight loss assoc with random plasma gluc of 200 or more
-plasma gluc of 126 or more after an overnight fast, on more than 1 occasion
-ketonemia, ketonuria, or both
-islet autoab's are freq present

2

DM type 2- essentials of dx

-many pts > 40 yo and obese
-polyuria and polydipsia. Ketonuria and weight loss generally are uncommon at time of dx. Candidal vaginitis in women may be the initial manifestation. Many pts have few or no sx's
-plasma glucose 126 after overnight fast on more than 1 occasion. 2 hrs after 75g oral glucose, diagnostic values are 200 or more.
-HbA1c 6.5% or more
-HTN, dyslipidemia, and atherosclerosis often assoc

3

DM- environmental factors

-not known
-infections with viruses (mumps, rubella, coxsackie B4), consumption of cow's milk
-hygiene hypothesis- immune system becomes dysregulated b/c of less childhood infections

4

Acanthosis nigricans

-nape of neck
-typical dark and velvety appearance

5

medications that lower glucose levels by their actions on the liver, muscle, and adipose tissue

Metformin!!
-inc hepatic AMP protein kinase activity
-first-line tx for type 2 DM!!

6

Short-Acting Insulin Preparations- regular insulin

-30 min after S/C injection
-lasts 5-7 hrs
-IV used for diabetic ketoacidosisi

7

ocular complications

-cataracts
-retinopathy- nonproliferative and proliferative
-glaucoma

8

diabetic neuropathy

-distal symmetric polyneuropathy
-isolated peripheral neuropathy
-autonomic neuropathy

9

autonomic neuropathy

-metoclopramide can help gastroparesis
-erythromycin- improve gastric emptying
-diarrhea-- responds to antibiotics
-ED

10

skin and mucous membrane complications

-candidal infection
-eruptive cutaneous xanthomas (when triglycerides are high)
-necrobiosis lipoidica diabeticorum- ant surfaces of legs and dorsal surfaces of ankles- plaques with demarcated borders and a glistening yellow surface
-shin spots

11

surgery

-insulin antagonists are mobilized
-leads to hyperglycemia and even ketoacidosis

12

type 2 DM- minor surgical procedures

-no insulin on day of operation
-start 5% dextrose infusion
-monitor fingerstick blood gluc and give S/C short-acting insulin every 4-6 hrs
*same for major procedure- if not satisfactory, then IV insulin infusion

13

type 1 DM- minor surgical procedures

-D/C the pump the evening b/f the procedure and given 24-hr basal insulin
-on day of procedure, start 5% dextrose
-monitor blood gluc and give S/C short-acting insulin every 4-6 hrs

14

ICU pts with diabetes and new-onset hyperglycemia with blood gluc > 180- tx?

-insulin- aiming for target gluc levels b/w 140-180

15

diabetic ketoacidosis- fluid replacement

-usually fluid deficit is 4-5 L
-0.9% saline solution first- 1 L/h over first 1-2 hrs, then rate of 300 mL/h
-use 0.9% saline unless serum Na > 150 (then use -.45% saline)
-when blood glucose falls to 250- fluids changed to a 5% gluc-containing solution- maintain serum gluc at 250-300

16

diabetic ketoacidosis- insulin replacement

-regular insulin given IV in a loading dose of 0.1 unit/kg as a bolus to prime the tissue insulin R's
-IV doses of insulin are continuously infused

17

hyperglycemic hyperosmolar state- flud replacement

-start with 0.9% saline (if hypovolemia present- hypotension, oliguria)
-other cases- start with 0.45% saline
-4-6 L may be required in first 8-10 hrs
-careful monitoring of pt- proper Na and water replacement
-once blood gluc reaches 250- fluid replacement should include 5% dextrose in either water, 0.45% saline solution, or 0.9% saline solution
-maintain glycemic levels of 250-300- reduce risk of cerebral edema
-restore urinary output to 50 mL/h

18

Lactic Acidosis- essentials of dx

-severe acidosis with hyperventilation
-blood pH < 7.30
-serum bicarbonate < 15
-anion gap > 15
-absent serum ketones
-serum lactate > 5 mmol/L

19

Lactic Acidosis- sx

-main clinical feature- hyperventilation
-can occur in metformin-treated pts!!! (kidney and liver insuff, HF- contraindicated)

20

Lactic Acidosis- lab

-plasma bicarbonate and blood pH are low- severe metabolic acidosis
-high anion gap > 15
-dx confirmed- plasma lactic acid conc > 5

21

Lactic Acidosis- tx

-tx the cause
-alkalinization with IV NA HCO3 to keep the pH > 7.2