5 Flashcards
Most devastating, acute complication that is likely to occur with DKA
cerebral edema
clues to DKA
N/V, severe abdominal pain, fatigue
recent history of polyuria, polydipsia, and polyphagia
signs of dehydration: increased pulse, decreased BP, and increased capillary refill time. also labored breathing, consistent with Kussmaul respirations
“fruity breath,” caused by acetone formation
DKA
A severe insulin deficiency that leads to decreased peripheral glucose utilization.
Resultant complications of DKA include ?
hypertonic dehydration, ketonuria, and metabolic disturbances including increased serum anion gap, decreased serum bicarbonate, decreased serum pH.
Kussmaul respirations
Rapid, deep respirations associated with the compensatory respiratory alkalosis of DKA in response to the body’s metabolic acidosis
DKA lab evaluation
serum glucose, serum electrolytes including blood urea nitrogen (BUN) and creatinine, serum pH, and urinary ketones
often: CBC and bld/ur cultures, as may be preceded by infection
DKA serum findings
elevated glucose (usually 400-800 mg/dL) and metabolic acidosis (decreased bicarbonate level with increased anion gap), hyperkalemia (although total body potassium is invariably low), hyponatremia (dilutional from increased serum glucose)
true serum sodium concentration can be calculated how?
by adding 1.6 mEq/L for every 100 mg/dL of serum glucose above the normal range
initial treatment of DKA (after ABCs)
dehydration correction (5-10%)
bolus of 10 mL/kg of isotonic fluids is given prior to treatment with insulin
remainder of the calculated fluid deficit should be replaced over the next 48 hours
-potassium and phosphate added to IVF
after initial fluid bolus given in DKA
IV insulin infusion should also be initiated after the initial bolus at a rate of 0.05 to 0.1 units/kg/h with the infusion titrated based on the patient’s hourly glucose concentration
when to stop insulin therapy in DKA?
when anion gap has closed (last thing)
also: glucose has normalized, bicarbonate level is greater than 18 mEq/L, and her serum pH is greater than 7.3
transition to subQ insulin
how to prevent inadvertent hypoglycemia during the therapy phase of DKA
dextrose is added to the IV fluids once serum glucose levels reach 250 to 300 mg/dL
s/s of cerebral edema
severe headache, sudden deterioration of mental status, bradycardia, hypertension, and incontinence
if signs of cerebral edema, treat immediately with ?
IV mannitol and hyperventilation
management of Turner’s syndrome
Monitor for cardiac and renal abnormalities, growth hormone for short stature, and laboratory work to check for hypothyroidism and dyslipidemia
initial diagnostic tests for Turner’s
karyotype and ECHO (coarctation)
Turner’s features
webbed neck, lymphedema (swollen hands and feet), low set ears, broad chest with wide spaced nipples, drooping eyes, and a higher incidence of hip dysplasia, cubitus valgus, and low posterior hairline, frequent OME–>hearing loss, strabismus, congenital glaucoma and anterior chamber deformities
later findings: short stature or primary amenorrhea
cubitus valgus
Physical finding in which the angle between the shaft of the ulna and humerus is increased greater than 15% in females.
Turner’s chromosome analysis
single X chromosome with absence of all or part of the second sex chromosome (45 X). Mosaicism can be seen and can ameliorate expression of some of the clinical findings
caused by nondisjunction, not inherited
other cardiac conditions seen in Turner’s
aortic root dilation, bicuspid aortic valve, MVP, and hypoplastic left heart syndrome
autoimmune conditions associated with Turner’s
Hashimoto thyroiditis, celiac disease, IBD, glucose intolerance
consider treating Turner’s with
GH and estrogen
other Turner findings
pigmented nevi, osteoporosis, inflammatory bowel disease, neuroblastoma, and liver disease.
scoliosis, kyphosis, lordosis
