Adult Endocrine Flashcards by Cassie Dasmarinas

What are the guidelines for diagnosing DM based on

Fasting Plasma glucose:

Two hour plasma glucose:

HbA1C:

FPG: >126

OGTT: >200

HbA1C: >6.5%

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What test should be ordered every three months on diabetic patients that is a measure of the “average” glucose levels

HbA1C

(aka hemoglobin A1c, glycosylated hemoglobin)

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

Mental status change

Abdominal Pain

Dehydration

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Why could DM present with altered mentation?

Due to high or low glucose levels

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Why could DM present with abdominal pain?

due to diabetic ketoacidosis

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What are the possible etiologies of DKA?

Inadequate Insulin

Infection

Infarction

Surgery

Drugs

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What are the initial signs of DKA?

anorexia

n/v

polyuria/polydipsia

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What are some serious signs and symptoms of DKA?

Coma

AMS

Kussmaul respirations

Acetone breath

Dehydration

Tachycardia

Hypotension

Fever

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Which type of metabolic disturbance will be seen with DKA?

HAGMA

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What is the treatment for DKA?

ICU admit

monitor status, vitals, glucose, renal fxn, a/b status, K and other electrolytes

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What is one method of fluid replacement in DKA?

1-2-3 rule

2-3L if NS over the first 1-3 hours

then, 1/2 strength saline at 150ml/h

fluid deficit is usually 3-5L

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what is the insulin dosing for DKA?

10-20 units IV or IM

then, 5-10 units/hr cont. IV

increase if no response in 1-2hrs, can be written to titrate

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What labs/imaging are ordered to look for the cause of DKA?

EKG

CXR

Drug screen

hx from family/pt

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What is the monitoring protocol for DKA?

BSG hourly

Electrolytes q2-4hrs +/- ABG

Vitals, mental status, and fluids hourly

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When should K be replaced in DKA?

when serum K drops below <5.5

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

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What are the three main goals of treating DKA?

increase rate of glucose utilization (gluc: 120-250)

reverse ketonemia and acidosis

correct depletion of water and electrolytes

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When DKA is resolving, and pt is able to tolerate food, when should intermediate or long-acting insulin be added?

once anion gap has normalized and overlap IV and SQ insulin by about 30-60min

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What is Non-Ketotic Hyperosmolar State (NKHS)?

Insulin def.

Inadequate fluid inake

Osmostic diuresis induced by hyperglycemia

NO KETONES

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What are some precipitating factors for NKHS?

sepsis

glucocorticoids

Phenytoin

thiazides

dehydration

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What are the sypmtoms of NKHS?

polyuria/polydipsia

AMS

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What is the fluid replacement protocol for NKHS?

2-3L of NS over first 1-3hrs

correct the deficit of 8-10L over the next 24-48hrs with 1/2NS

when glucose reaches 250, switch to D5 1/2NS at 100-200ml/hr

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What is the insulin administration for NKHS?

regular insulin at 5-10u IV

3-7u cont.

transition when able to tolerate PO

monitor, replace K, investigate cause as with DKA

What are the main differences between NKHS and DKA?

fluid deficit is much greater in NKHS

drugs can contribute to NKHS

N/v, abdominal pain, ketoacidosis and kussmail resp. are absent in NKHS

What are the similiarities between NKHS and DKA?

insulin def. and glucagon excess (absolute or relative)

volume depletion

AMS

critical conditions

What are some of the long term complications of DM?

cardiovascular disease (main cause or mortality) coronary artery disease

What HbA1C value indicates good control?

6.5 or less lower is usually better, but consider hypoglycemia contributing to syncope and falls, esp. in elderly

What is a form of autonomic neuropathy?

Diabetic Gastropathy variable stomach emptying can require varying amounts of insulin

How can nephropathy be screened for?

random urine sample protein should be \<300mg/24hr

What is the earliest measurable sign of proteinuria and nephropaty?

microalbuminuria 30-300mg can do a random urine sample or a microalbumin/creatinine ratio which is more accurate

When is a 24hr urine collection used?

Not routinely, only in screening/monitoring for more advanced kidney disease can measure large amounts of protein, but need to obtain a serum creatinine at same time to determine creatinine clearance can be difficult to remember to collect urine/difficult to preform

What should be ordered quarterly on diabetic patients?

HbA1C Revire SGM log Foot inspection

What should be done annually for diabetic monitoring?

dilated eye exam urine protein screening (microalbumin/cr ratio) monofilament testing

What are some general foot care recomendations?

Daily inspection Wear prescription shoes Moisturize but avoid under/between toes See podiatry

What behavior is the single most additive risk for vascular disease?

Smoking

What are the major characteristics of type I DM?

Absolute insulin def Absolute glucagon excess Volume depletion AMS autoimmune dz

What are the characteristics of type 2 DM?

Relative Insulin def. Relative Glucagon excess Volume depletion AMS obesity/inactivity

What are the s/s of hyperthyroidism?

"Hyped" lid lag/exophthalmos bruits tachycardia tremor diaphoresis gynecomastia heat intolerance weight loss diarrhea

What is the source of dysfunction in 1', 2', and 3' thyroid disorders

1': thyroid itself is dysfunctional 2': pituitary dysfunction 3': central/hypothalamic dysfunction

Name the Condition: Increased TSH Decreased FT4

Primary Hypothyroid

Name the Condition? Decreased TSH Increased FT4

Primary Hyperthyroidism

Name the condition Increased TSH Increased FT4

TSH producing tumor

Name the condition Decreased TSH Decreased FT4

Central hypothyroidism

What should be done if thyroid labs are abnormal in critically ill patients?

Be cautious diagnosing thyroid conditions in critically ill patients as protein shifts, metabolism and maladaptive processes can be contributing to the abnormal results

Are thyroid nodules typically benign or malignant?

benign (even the "cold" ones)

Are cold or hot nodules more likley to be malignant?

When compared, cold nodules are more likely to be malignant than warm or hot nodules

What nerve can be damaged with thyroid surgery?

Recurrent laryngeal nerve

What other endocrine structure can be damaged with thyroid surgery?

Parathyroids

What are the factors that affect calcium and vitamin D homeostasis?

bon, kidney and intestines respond to low Ca levels by increasing PTH PTH increases tubular reabsorption of Ca and stimulates renal 1,25(OH)2D production which helps intestinal absorption of Ca

If Ca and PO4 are moving in opposite directions, what is the issue?

PTH imbalance

If Ca and Po4 are moving in the same direction, what is the issue?

Vitamin D issue

What are five causes of hypercalcemia?

parathyroid related malignancy related vitamin d related associated with high bone turnover associated with renal failure

What EKG change may be seen on hypercalcemia?

shortened QT interval

What is the treatment for hypercalcemia of malignancy?

When presenting with AMS and/or EKG changes, treat with aggressive volume expansion with isotonic saline