Adult Endocrine Cases (Kirila) Flashcards
What is the most commonly used monitor for diabetes mellitus?
Accucheck
Basal insulin
long acting insulin used to achieve a steady state of glucose control
Bolus insulin
adjusted at mealtime and based on a “sliding scale”
Signs and symptoms of DM
polyuria, polydipsia, nocturia, blurred vision, weight loss and frequent recurrent infections (yeast vaginitis)
HBA1c
average 3 month glucose
DKA is most likely seen in which DM
DM1
NKHS is most likely seen in which DM
DM2
What is the most likely predisposing factor to DKA
typically in DM1 due to inadequate insulin administration
Clinical signs and symptoms of DKA
Kussmaul respirations and acetone (fruity) breath odor
dry mucous membranes, poor skin tugor, altered mental function, n/v
Treatment of DKA
admit to ICU; frequent monitoring of general status; acid-base status, renal function and monitor potassium and other electrolytes (**consider K+ replacement if serum K+ <5.5)
1-2-3 rule in fluid replacement in DKA
1 method
2-3 liters of normal saline
fluid deficit is often 3-5 liters
**consider K+ replacement if serum K+ <5.5
What are some things to keep in mind when supplementing K+ in DKA treatment
renal function
baseline EKG (continuous cardiac monitoring)
verify urinary output and measure hourly
DKA treatment goals
increase rate of glucose utilization; goal 150-250 mEq/dL
reverse ketonemia and acidosis
correct depletion of water and electrolytes
When are you able to start intermediate or long acting insulin in the case of DKA?
when patient is able to eat; mental status improved, no n/v, no abdominal pain, anion gap is normalized, allow overlap timing of IV and SQ insulin (30-60mins)
Non-Ketotic Hyperosmolar State (NKHS)
also called Hyperglycemic Hyperosmolar State (HHS);
