Planning Management

Question 1

What does HONK stand for?

Answer 1

Hyperglycaemia (usually >35mmol/L)
HO (hyperosmolar: osmolality over 340mmol/L (calculated by (x2 Na + x2 K) + urea + glucose)
NK (nonketotic, i.e. no ketones in blood or urine).

HONK management is the same as DKA management (see Fig.
4.11), except half the rate of fluids is required

Question 2

Treatment of hypoglycaemia

Answer 2

If the patient is able to eat then give a sugar-rich snack, e.g. orange juice and biscuits.

However, if unable to eat (i.e. drowsy/vomiting)
give IV glucose via a cannula, e.g. 100mL 20% glucose

If unable to eat and no cannula give IM glucagon 1mg

Question 3

Oxygen management of COPD patients who are not critically unwell

Answer 3

Prior to availability of blood gases, use a 28% Venturi mask at 4 l/min and aim for an oxygen saturation of 88-92% for patients with risk factors for hypercapnia but no prior history of respiratory acidosis

adjust target range to 94-98% if the pCO2 is normal

Question 4

Contraindication of arachis oil?

Answer 4

Nut allergy

Question 5

Contraindication of ispaghula husk? (bulking agent)

Answer 5

Faecal impaction
Colonic atony

Question 6

Contraindication of bisacodyl?

Answer 6

Acute abdomen

Question 7

Contraindication of phosphate enema?

Answer 7

Acute abdomen

Question 8

Contraindication for all laxatives

Answer 8

Bowel obstruction

Question 9

When should systemic steroids be tapered?

Answer 9

received more than 40mg prednisolone daily for more than one week

received more than 3 weeks treatment

recently received repeated courses