Chem Path: Diabetes CPC Flashcards
What happens in hyper osmolar ketotic coma?
Metabolic alkalosis because of loss of H+ in vomiting
What happens to potassium during vomiting and what does that lead to?
Loss of K+ leading to hypokalaemia and that leads to metabolic alkalosis as you swap k+ for HCO3
In summary what are the pH, hco3 and co2 levels in metabolic alkalosis
pH high
High HCO3
High CO2 to compensate
What is blood osmolality and what does a high osmolality suggest
Concentration of particles/ions in it. It mean the blood is very concentrated - blood is like treacle
How would the anion gap be in DKA?
High anion gap as ketones are anions
What are the 3 ways of losing potassium?
GI, cellular redistribution and renal loss
Explain the GI loss of k+
D&V
Explain the renal loss of k+
Thiazide diuretics, renal tubular acidosis and hyperaldosterone
Explain the redistribution of k+ leading loss of k+
Insulin, beta agonists and alkalosis (due to exchange with H+)
How would you treat excess k+
Insluin, HCO3 and salbutamol
Which ion do you need to make PTH
Magnesium
Longstanding HTN, diabetes, common fractures, obesity and poor wound healing are features of what?
Cushings syndrome
Will pituitary ACTH suppress with high dose dexa test?
It should suppress a little. We do not do high dose dexa anymore.
What does ectopic ACTH cause and why?
Severe hypoK+ as cortisol will bind to the MR receptors causing excretion of k+
How does vocal resonance present in effusions
Decreased
How does vocal resonance present in collapse or consolidation
Increased
What can hypokalaemia lead to?
Nephrogenic DI
What is osmotic diuresis
Low K+ high glucose. The presence of certain solutes in urine draws out water leading to dehydration
Why should you rehydrate cautiously in a patient with hypoK and dehydration?
IV K+ can cause asystole
How to differentiate between ATN and CKD?
Renal biopsy
How to treat ATN?
Rehydrate or dialyse till normal
What are the inferior leads in an ecg
II, III and aVF
What are the lateral leads in an ecg
I, AVL, AVR, V5 and V6
What are the anterior leads in an ecg
V3. V4
What are the septal leads in an ecg
V1 and V2
