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ENDO > Adult Endo > Flashcards

Adult Endo Flashcards

1
Q

What are clinical presenting sx of DM

A

Polyuria/Polydipsia
Nocturia
Blurred Vision

Weight Loss
Infections

PNB WI

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2
Q

What are the guidelines for diagnosing DM based on

1) Fasting Plasma glucose:
2) Two hour plasma glucose:
3) HbA1C:

A

1) FPG: >126
2) OGTT: >200
3) HbA1C: >6.5%

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3
Q

1) What test should be ordered to check that diabetic patient has average glucose levels?
2) How often?

A

1) HbA1C
(aka hemoglobin A1c, glycosylated hemoglobin)

2) Every 3 months

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4
Q

What are three common presenting signs and symptoms that may be caused by DM?

A

Mental status change
Abdominal Pain
Dehydration

MAD

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5
Q

Why could DM present with altered mentation?

A

Due to high or low glucose levels

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6
Q

Why could DM present with abdominal pain?

A

due to diabetic ketoacidosis

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7
Q

What are the possible etiologies of DKA?

A 
Surgery
Inadequate Insulin
Infection 
Infarction
Drugs

SIIID

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8
Q

What are the initial signs of DKA?

A

Polyuria/polydipsia
Anorexia
Nausea/Vomiting

PAN

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9
Q

What are the progressive symptoms of DKA?

A

Coma
Abdominal Pain
Altered Mental Status

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10
Q

DKA Serious Signs?

A

Poor Skin turgor
Acetone Fruity Breath
Kussmaul Respirations
Dry Mucus Membranes

Fever
Hypotension
Tachycardia

PAKD FHT

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11
Q

1) What metabolic Disturbance will be seen for DKA?
2) What is the treatment for DKA?
3) What do you monitor for (aside from general status, vitals)

A

1) HAGMA
2) ICU
3) Acid Base, Renal Function, Electrolytes

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12
Q

Fluid Method in DKA
1) What is one method of fluid replacement in DKA?

2) How does it work?
3) What happens when glucose reaches 250 mg/dl?
4) What will fluid deficit be?

A

1) 1-2-3 rule

2) 2-3 Liters of Normal Saline over first 1-3 hours
Then
½ strength saline at 150 ml/hr

3) Switch to D5 1/2 NSat 100-200 ml/hr
4) 3-5 liters

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13
Q

1) What is the insulin dosing for DKA?

2) What do you do if there is no response in 1-2 hours?

A

1) First: 10-20 units IV or IM
Then: 5-10 units/hr continuous IV

2) Increase Insulin

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14
Q

What is the initial monitoring in DKA and how often?

A

1) BSG hourly (bedside glucose)

2) Electrolyte check every 2-4 hours

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15
Q

When should Potassium be replaced in DKA?

A

When Serum Potassium drops below 5.5 mEq/L

monitor renal fxn, EKG, and urinary output (hourly)

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16
Q

What are the three main goals of treating DKA?

What is the Glucose goal?

A

1) Reverse Ketonemia and Acidosis
2) Increase rate of glucose utilization
3) Correct depletion of Water and electrolytes

Glucose Goal: 120-250 meq/dL

RIC

17
Q

1) In an DKA Patient, when can Patient Start Intermediate or Long-Acting Insulin?
2) What should be be overlapped?
3) For how long?

A

1) Patient is able to eat and Anion Gap normalized
2) Timing of IV insulin with SQ insulin
3) 30-60 minutes

18
Q

What are the causes of Non-Ketotic Hyperosmolar State (NKHS)?

A

1) Osmotic Diuresis caused by hyperglycemia
2) Inadequate Fluid Intake
3) Insulin Deficiency

Oii

19
Q

What are some precipitating factors for NKHS?

A

Sepsis
MI
Glucocorticoids

(SMG)

20
Q

What are the symptoms of NKHS?

A

Polyuria/Polydipsia

Altered Mental Status

21
Q

1) What is the fluid replacement protocol for NKHS?
2) What is the fluid deficit?
3) What do you do to the fluid deficit?
4) What do you do when Glucose reaches 250 mg/dL

A

1) 2-3 L NS for first 1-3 hours
2) 8-10L
3) Reverse using ½ strength saline

4) Switch to D₅ ½ NS at 100-200 ml/hr
(5% Dextrose and ½ strength Saline)

22
Q

What is the insulin administration for NKHS?

Regular Insulin

A

5-10 units IV bolus

3-7 units continuous IV

23
Q

What are the main differences between NKHS and DKA?

  • Fluid Deficit?
  • Drugs
  • What is missing in NKHS?
A

1) Higher Fluid Deficit in NKHS
2) Drugs can contribute to NKHS
3) N/V, Abdominal Pain, Ketoacidosis, Kussmaul

24
Q

What is In DKA and Not NKHS?

A 
Ketoacidosis
Kussmaul respiration
Vomiting
Abdominal Pain
Nausea

KK VAN

25
Q

What are the Similarities between NKHS and DKA?

A

Volume Depletion
Altered Mental Status
Insulin Deficiency (Absolute or Relative)
Glucagon Excess (Absolute or Relative)

VAIG

ENDO (6 decks)

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