CIS/HPS 2: Endocrine

Question 1

Using the mnemonic GOLDMARK, what are the causes of high anion gap metabolic acidosis?

Answer 1

• G: glycols (ethylene glycol/propylene glycol)
• O: oxoproline, metabolite of paracetamol
• L: lactate, lactic acidosis
• D: d-lactate (GI disorders)
• M: methanol
• A: aspirin
• R: renal failure
• K: ketoacidosis

Question 2

Where should a patient with DKA or hypoglycemia be admitted and what monitoring do they need?

Answer 2

ICU: one-on-one nursing, continous cardiac monitoring, and frequent lab eval.

Question 3

What is the most important tx for DKA?

Answer 3

High volume IV fluids

Question 4

What are the IV fluid choices for DKA and what needs to be monitored with each?

Answer 4

• NS: monitor Na⁺ and Cl^- in addition to glucose and anion gap, pH
• 1/2 NS: may be necessary
• D5 1/2 NS: IV support with D5 until anion gap closes, pH normalizes; may also require K+, Mg, or phosphorus supplementation

Question 5

What is the formula to correct sodium when sugar is high?

Answer 5

Na + [(glucose - 100) x 0.016]

Question 6

Which electrolytes are part of a CMP?

Answer 6

• Sodium
• Potassium
• Chloride
• Calcium

Question 7

How is the type of IV fluid for treating DKA changed throughout tx and why?

Answer 7

Initially NS –> switch to D5 1/2 NS when pt on insulin gtt when their glucose gets to 250 to prevent hypoglycemia

Question 8

What is the goal of tx for DKA?

Answer 8

FIX the acid-base disturbance! NOT bring sugar to normal level

Question 9

When can you end the tx of DKA and what is the timeline/procedure?

Answer 9

• When anion-gap is closed
• Switch to SQ insulin, stop gtt 2 hours after administration of SQ long-acting (will go back into DKA if you stop too soon!)

Question 10

What are the most common cause of clinically significant hypoglycemia?

Answer 10

Medications! –> exogenous insulin, sulfonylurea and meglatinides and alcohol

Question 11

If patient with hypoglycemia is awake and alert, what is the treatment?

Answer 11

Fast-acting CHO such as oral glucose tablet or hard candy

Question 12

If patient with hypoglycemia has decreased level of consciousness or seizure, what is the treatment?

Answer 12

IV D50, glucagon IM

Question 13

What is the Chapman’s Point for the Pancreas?

Answer 13

R 7th ICS

Question 14

What are 2 areas to check for the parasympathetic viscerosomatic changes in DKA for the pancreas and kidney?

Answer 14

• OA
• AA

Question 15

What is the viscerosomatic sympathetic levels for the pancreas and kidney that should be checked in the setting of DKA?

Answer 15

• Pancreas = T5-T10 on R or b/l
• Kidneys = T10-L2 on R

Question 16

What is the Chapman’s Point for the Kidney?

Answer 16

1’’ superior and 1’’ lateral to the umbilicus

Question 17

Which cranial OMM techniques could be utilized to promote lymphatic flow and restore CRI in pt with complication of cerebral edema s/p DKA?

Answer 17

CV4 or condylar decompression

Question 18

The right lymphatic duct drains which areas?

Answer 18

Drains R head and neck + right UE + all lung lobes except upper left