Chempath - hypoglycaemia + clin chem CPC Flashcards
Acute Mx of an alert and orientated hypoglycaemic patient
ORAL carbohydrates
Fast - juice/sweets
Long acting - sandwich
Consider IM glucagon 1mg
2 e.g. of mx for an acutely drowsy (but intact swallow) + hypoglycaemic patient
Glucagel/hypostop
2 options for IV treatment of hypoglycemia
100mL of 20% glucose
or
50mL of 50% glucose mini-jet
What do you need to consider when assessing use of IM glucagon in a hypoglycaemic patient?
Glucagon takes 15-20 mins to work
Only works if there are enough glycogen stores present
Danger of rebound hypoglycemia
2 forms of symptoms with hypoglycaemia?
Sympathetic - sweating, nausea, palpitations
Neuro - Confusion, seizures, incoordination
Hormonal response to low glucose levels?
Increased cortisol, GH, ACTH, adrenaline
Causes of hypoglycaemia in a non-diabetic individual
Fasting Organ failure Exercise Insulinoma Drugs - EtOH,beta blockers Factitious
Causes of hypoglycaemia in a diabetic individual
Missed meal
EtOH
Exercise
Impaired aAWARENESS
Which 2 comorbidities are commonly associated with hypos in DM patients? Why?
Liver and renal failure - due to impaired clearance of DM drugs, therefore toxicity
Useful tests for differentiating the cause of hypoglycemia
Insulin, C-peptide, FFAs, ketones, drug screen
Hypoglycaemia due to excess injected insulin would result in a high or low C-peptide?
low
Hypoglycaemia with low insulin and C-peptide. What are the causes?
appropriate response to hypoglycaemia!
Starvation Exercise Critical illness Liver failure Anorexia Nervosa
What is 3-hydroxybutyrate?
Ketone body
A neonate has hypoglycaemia. What are the potential causes?
High ketones - prematurity (no glycogen stores), IUGR, SGA
Low ketones: inborn metabolic defects
If hypoglycaemia + high insulin levels, what are the potential causes?
Infant of GDM Insulinoma Excess DM drugs Beckwith Weidemann syndrome Nesidioblastosis
how are beta cells stimulated to release insulin?
Glucose enters, is metabolised to generate ATP
ATP closes the K+channel, and depolarisation –> Ca2+ influx and insulin exocytosis
MOA of sulfonylureas?
binds to Sur1 on K+ channel
MOA of sulfonylureas?
binds to Sur1 on K+ channel
Insulinoma - glucose, insulin and c-peptide level?
What syndrome is it associated with?
low glucose
high insulin + high c-peptid
Assoc with MEN1
Low glucose
Low insulin + c-peptide
No ketones and FFAs
What is the cause?
Non-islet cell tumour hypoglycaemia
i.e. paraneoplastic. Big IGF2 release from tumour –> stimulation of insulin receptor
how to confirm diagnosis of diabetes
HbA1c >6.5
3 main groups of causes of metabolic alkalosis
Loss Of H+ (vomiting)
ingestion of bicarb
Hypokalemia
NR of bicarbonate in an ABG?
8-14
Osmolality = ?
2(Na+K)+ urea + glucose
Causes of hypokalemia
GI: D+V, fistula
Insulin
Renal: Diuretics, excess aldosterone
Effect of insulin on Potassium?
Insulin –> hypokalemia
Which LFT is raised in acute MI?
Aspartate aminotransferase
ALT stands for…?
alanine aminotransferase
Why is there hypokalemia often seen in ectopic ACTH?
V high cortisol levels will eventually stimulate MC receptors –> increased aldosterone and K secretion
NR of plasma osmolality
275-295
What Ix is done to differentiate between acute and chronic renal failure
renal biopsy
Mx of acute tubular necrosis?
Dialysis
Top Sx in Paget’s disease of the skull
Deafness
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
Which measurements are raised in acute MI? state in order
- Troponin
- CK (MB)
- AST
- LDH
CK (MM) is from..?
skeletal muscle
which level (apart from phosphate) is low in primary hyperparathyroidism
Vitamin D
PTH stimulates 1alpha-hydroxylase, thus vitamin D is consumed
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
Mx of hyperkalemia in worsened ESRF
1) Calcium gluconate
2) insulin + dextrose
3) acute dialysis
2 indications for acute dialysis in CKD?
acidosis + hyperkalemia
3 structures of the portal triad
HPV
hepatic artery
bile duct
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
Best marker of glucose control over last 3 weeks?
last 3 months?
3 weeks: fructosamine
3 months: HbA1c
