Chempath - hypoglycaemia + clin chem CPC Flashcards

1
Q

Acute Mx of an alert and orientated hypoglycaemic patient

A

ORAL carbohydrates

Fast - juice/sweets
Long acting - sandwich

Consider IM glucagon 1mg

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2
Q

2 e.g. of mx for an acutely drowsy (but intact swallow) + hypoglycaemic patient

A

Glucagel/hypostop

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3
Q

2 options for IV treatment of hypoglycemia

A

100mL of 20% glucose

or

50mL of 50% glucose mini-jet

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4
Q

What do you need to consider when assessing use of IM glucagon in a hypoglycaemic patient?

A

Glucagon takes 15-20 mins to work

Only works if there are enough glycogen stores present

Danger of rebound hypoglycemia

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5
Q

2 forms of symptoms with hypoglycaemia?

A

Sympathetic - sweating, nausea, palpitations

Neuro - Confusion, seizures, incoordination

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6
Q

Hormonal response to low glucose levels?

A

Increased cortisol, GH, ACTH, adrenaline

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7
Q

Causes of hypoglycaemia in a non-diabetic individual

A
Fasting
Organ failure
Exercise
Insulinoma
Drugs - EtOH,beta blockers
Factitious
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8
Q

Causes of hypoglycaemia in a diabetic individual

A

Missed meal
EtOH
Exercise
Impaired aAWARENESS

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9
Q

Which 2 comorbidities are commonly associated with hypos in DM patients? Why?

A

Liver and renal failure - due to impaired clearance of DM drugs, therefore toxicity

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10
Q

Useful tests for differentiating the cause of hypoglycemia

A

Insulin, C-peptide, FFAs, ketones, drug screen

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11
Q

Hypoglycaemia due to excess injected insulin would result in a high or low C-peptide?

A

low

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12
Q

Hypoglycaemia with low insulin and C-peptide. What are the causes?

A

appropriate response to hypoglycaemia!

Starvation
Exercise
Critical illness
Liver failure
Anorexia Nervosa
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13
Q

What is 3-hydroxybutyrate?

A

Ketone body

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14
Q

A neonate has hypoglycaemia. What are the potential causes?

A

High ketones - prematurity (no glycogen stores), IUGR, SGA

Low ketones: inborn metabolic defects

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15
Q

If hypoglycaemia + high insulin levels, what are the potential causes?

A
Infant of GDM
Insulinoma
Excess DM drugs
Beckwith Weidemann syndrome
Nesidioblastosis
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16
Q

how are beta cells stimulated to release insulin?

A

Glucose enters, is metabolised to generate ATP

ATP closes the K+channel, and depolarisation –> Ca2+ influx and insulin exocytosis

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17
Q

MOA of sulfonylureas?

A

binds to Sur1 on K+ channel

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18
Q

MOA of sulfonylureas?

A

binds to Sur1 on K+ channel

19
Q

Insulinoma - glucose, insulin and c-peptide level?

What syndrome is it associated with?

A

low glucose
high insulin + high c-peptid

Assoc with MEN1

20
Q

Low glucose
Low insulin + c-peptide
No ketones and FFAs

What is the cause?

A

Non-islet cell tumour hypoglycaemia

i.e. paraneoplastic. Big IGF2 release from tumour –> stimulation of insulin receptor

21
Q

how to confirm diagnosis of diabetes

A

HbA1c >6.5

22
Q

3 main groups of causes of metabolic alkalosis

A

Loss Of H+ (vomiting)
ingestion of bicarb
Hypokalemia

23
Q

NR of bicarbonate in an ABG?

24
Q

Osmolality = ?

A

2(Na+K)+ urea + glucose

25
Causes of hypokalemia
GI: D+V, fistula Insulin Renal: Diuretics, excess aldosterone
26
Effect of insulin on Potassium?
Insulin --> hypokalemia
27
Which LFT is raised in acute MI?
Aspartate aminotransferase
28
ALT stands for...?
alanine aminotransferase
29
Why is there hypokalemia often seen in ectopic ACTH?
V high cortisol levels will eventually stimulate MC receptors --> increased aldosterone and K secretion
30
NR of plasma osmolality
275-295
31
What Ix is done to differentiate between acute and chronic renal failure
renal biopsy
32
Mx of acute tubular necrosis?
Dialysis
33
Top Sx in Paget's disease of the skull
Deafness
34
Once a blood test showing sky high ALP is done, what is a useful investigation to confirm Paget's disease of the bone?
Radio labelled Technetium scan
35
Which measurements are raised in acute MI? state in order
1. Troponin 2. CK (MB) 3. AST 4. LDH
36
CK (MM) is from..?
skeletal muscle
37
which level (apart from phosphate) is low in primary hyperparathyroidism
Vitamin D PTH stimulates 1alpha-hydroxylase, thus vitamin D is consumed
38
sudden dehydration --> AKI. which one changes the most - creatinine or urea?
Urea rises the most. If Creatinine is normal, then you know it is an acute problem
39
Mx of hyperkalemia in worsened ESRF
1) Calcium gluconate 2) insulin + dextrose 3) acute dialysis
40
2 indications for acute dialysis in CKD?
acidosis + hyperkalemia
41
3 structures of the portal triad
HPV hepatic artery bile duct
42
Why is giving bicarb BOLUS, v dangerous in DKA?
bicarb will raise the pH and will then cause a rise in Co2 by equilibrium. The CO2 crosses the BBB and worsens acidosis --> brainstem death - bicarb is useful if given by slow infusion
43
Best marker of glucose control over last 3 weeks? | last 3 months?
3 weeks: fructosamine | 3 months: HbA1c