ChemPath: Diabetes CPC Flashcards

1
Q

Define diabetes based on:

  1. Fasting plasma glucose
  2. 2-hour oral glucose tolerance test
  3. HbA1c
A
  1. Fasting plasma glucose
    • > 7 mmol/L
  2. 2-hour oral glucose tolerance test
    • > 11.1 mmol/L
  3. HbA1c
    • More than 48 mmol/mo (6.5%)
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2
Q

List some causes of metabolic alkalosis.

A
  • H+ loss (e.g. vomiting)
  • Hypokalaemia
  • Ingestion of bicarbonate
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3
Q

Why is respiratory compensation for alkalosis usually quite poor?

A

Metabolic alkalosis inhibits ventilation but ventilation must remain sufficient to maintain good oxygen levels

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4
Q

State the equation for plasma osmolality.

A

Osmolality = 2(Na + K) + Urea + Glucose

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5
Q

Equation of anion gap

A

Na + K - Cl - bicarb

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6
Q

List some causes of hypokalaemic alkalosis.

A
  • Intestinal loss (diarrhoea, vomiting, fistula)
  • Renal loss (minerlocorticoid excess, diuretics, renal tubular disease, osmotic diuresis, increased sodium delivery to distal nephron)
  • Redistribution (insulin, alkalosis, beta-agonists)
  • Rare (renal tubular acidosis type 1 and 2, hypomagnesaemia)

i.e. causes of hypokalaemia

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7
Q

Outline the relationship between hypokalaemia and alkalosis.

A
  • Low K+ leads to a shift of H+ into cells
  • This causes alkalosis
  • Similarly, low H+ will result in a shift of K+ into cells
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8
Q

Complications of hypo and hyper kalaemia

A

Hypokalaemia - VF

Hyper - Asystole

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9
Q

How can ectopic ACTH be distinguished from other causes of Cushing’s syndrome?

A

Ectopic ACTH cannot be suppressed by high-dose dexamethasone suppression test

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10
Q

Which cause of Cushing’s syndrome is most commonly associated with hypokalaemia?

A

Ectopic ACTH

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11
Q

Causes of ectopic ACTH

A

Cancers

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12
Q

Why might a patient with Cushing’s syndrome be hypotensive?

A

Diuresis can lead to dehydration and hypotension

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13
Q

What is the only definitive way of distinguishing acute renal failure from chronic renal failure?

A

Renal biopsy

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14
Q

How might ATN due to dehydration be treated?

A

3 weeks of dialysis

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15
Q

What treatment might diabetic glomerular kidney disease require?

A

This can result in end-stage renal failure requiring dialysis.

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16
Q

What does slow-onset upper motor neurone lesions in a cancer patient suggest?

A

Brain metastases