Chempath 21: Diabetes CPC Flashcards
A Fasting plasma glucose of >……. defines diabetes
> 7mmol/L
A 2 hour plasma glucose in a GTT > …….. defines diabetes
> 11.1mmol/L
A HbA1c > ……. defines diabetes
> 48mmol/mol (6.5%)
Why is respiratory compensation for metabolic alkalosis limited ?
If you want to increase CO2 by restricted breathing it will be limited because you require a sufficient amount of ventilation to maintain oxygen levels
DKA is a metabolic acidosis with a ……….. anion gap
High
Anion gap = Na + k - Cl - HCO3
Normal is about 12 (8-16)
If >12 suggests other anions such as ketones
How does the dialysis regime differ in treatment of ATN and diabetic glomerular kidney disease ?
In ATN 3 weeks of dialysis should allow recovery of renal function
In diabetic glomerular kidney disease the patient will require lifelong dialysis of transplant.
Which of the following diseases is most likely to be associated with AA amyloidosis ?
A) Alzheimer’s disease B) Diabetes Mellitus C) Plasmacytoma D) Rheumatoid Arthritis E) Thyroid carcinoma
D) Rheumatoid Arthritis
Rheumatoid arthritis is an inflammatory condition which contribute to serum amyloid associated (AA) protein production.
Alzheimer’s causes localised amyloid deposition know as amyloid angiopathy
Diabetes mellitus type 2 causes localised Islet cell amyloid deposition
Plasmacytoma (multiple myeloma) causes Light chain (AL) amyloid production
Medullary thyroid carcinomas cause local amyloid production in their stroma
Phaeochromocytoma shows increased levels of ……… in the urine. Whereas a congenital Neuroblastoma of the adrenal gland would more likely show …….. in the Urine
They both show catecholamines in the Urine but:
Phaeochromocytoma shows more : VMA
Neuroblastoma shows more: HMA
HMA is a more mature metabolite of epinephrine (adrenaline) than VMA is and has a better prognosis.
What are 3 causes of metabolic alkalosis
H+ loss (eg vomiting)
Hypokalaemia
Ingestion of bicarbonate
List causes of hypokalaemic alkalosis
Intestinal loss - diarrhoea - vomiting - fistula Renal loss - mineralocorticoid excess - diuretics - renal tubular disease Redistribution - Insulin (drives potassium into cells) - Alkalosis - Beta agonists
What is the link between hypokalaemia and alkalosis
low K+
shifts H+ ions into cells
causing extracellular alkalosis
Hypokalaemia causes alkalosis
And alkalosis causes hypokalemia
Why can ectopic ACTH cause hypokalaemia
Causes such high levels of cortisol that they start binding aldosterone receptors