Krila DM

Question 1

What pneumonic is used for mental status changes?

Answer 1

AEIOUTIPS

Alcohol, epilepsy, infection, overdose, uremia, trauma, insulin, psychosis or poisoning, stroke

Question 2

What pneumonic is used for abdominal pain differential?

Answer 2

BAD GUT PAINS

D stands for diabetic ketoacidosis

Question 3

What is DKA and HHS/NKHS usually found in? What are the differences?

Answer 3

DKA in T1 (younger pt), HHS/NKHS in T2 (older pt)

Fluid loss: DKA < HHS
N/V: DKA has them, HHS does not
Abd pain: DKA has them, HHS does not
Kussmaul resp: DKA has them, HHS does not

Question 4

What things can initiate DKA?

Answer 4

Stressors (surgery, infection, infarction), Drugs (cocaine), not taking insulin

Question 5

What are the acute sxs of DKA? Progressive sxs?

Answer 5

Anorexia, N/V, polyuria, thirst (polydipsia)

Abd pain, mental status changes, coma, dehydration signs (dry mucous membranes, poor skin turgor), Kussmaul respirations (rapid and deep), breath odor (fruity, nail polish remover), fever, tachycardia, hypotension

Question 6

What are lab values seen in DKA?

Answer 6

Hyperglycemia, ketosis, metabolic acidosis w/ high anion gap, hyperkalemia (acidic pH causes K to move out of cells, cells are K starved, when giving insulin tx pt must ALSO receive K even though labs may be normal/high)

Question 7

What pneumonic is used for a metabolic acidosis differential?

Answer 7

MUDPILES
Methanol, uremia, DKA, paraldehyde (anti-convulsant), isopropyl alcohol (antiseptic) and iron and INH (isoniazid, TB med), lactic acidosis, ethylene glycol (antifreeze), salicylates (NSAIDs)

Question 8

What is measured sodium in hyperglycemia? Potassium? Lipids? CBC?

Answer 8

Low
Body deficit but labs will be normal/high d/t acidosis
High
Possible leukocytosis if infection is cause

Question 9

What’s the tx in DKA and HHS?

Answer 9

Fluids (1-2-3 rule)
Insulin (IV and/or IM)
Eval for underlying cause
Clinical status hourly
BSG hourly
Electrolytes 2-4 hours
Potassium replacement if levels are below 5.5

Question 10

What is the glucose goal in a DKA pt?

Answer 10

150-250 meq/dL

Question 11

When can you feed a DKA pt?

Answer 11

When their mental status improves, they no longer have abd pain, and there’s no N/V

Question 12

What medications can initiate NKHS (non-ketoic hyperosmolar sate)?

Answer 12

Phenytoin, Thiazide diuretics, Glucocorticoids

Question 13

What are the expected lab finding in HHS?

Answer 13

High corrected sodium
Only mild acidosis and elevated anion gap
Moderate ketonuria

Question 14

What is the major cause of mortality in T2 diabetics?

Answer 14

Cardiovascular dx

Question 15

What HbA1C score is considered satisfactory?

Answer 15

< 7.0

Question 16

What blood sugar level begins glucose interference w/ neutrophils?

Answer 16

150

Question 17

How much of a wt loss can significantly improve a diabetics health outlook?

Answer 17

10 lbs, via TLC (therapeutic lifestyle changes)

Question 18

What should be checked quarterly in a diabetic? Annually?

Answer 18

Foot ulcers, A1C, BG log

Dilated eye exam, urine protein screening, monofilament testing