CR - Endocrine, Metabolic & Nutritional Disorders Flashcards
What are the electrolyte abnormalities seen in Addison’s disease?
Hyponatremia (most common)
Hyperkalemia (second most common)
Hypercalcemia
Hypomagnesemia
Clinical presentation: a patient complains of sudden onset of shortness of breath while dining out in a restaurant; he was not swallowing food when the symptoms began. Physical findings include inspiratory stridor and bilateral expiratory wheezing.
What is the most likely diagnosis?
Acute anaphylactic reaction
What therapy is indicated for the alcoholic who is acutely ill, dehydrated, and has the following laboratory values?
Glucose 140
Blood alcohol 0
pH 7.18
Serum ketones elevated
This patient has alcoholic ketoacidosis.
The treatment consists of fluid restoration and glucose. Some patients may have even modest hyperglycemia, but “refeeding” usually corrects this. Bicarbonate is not indicated.
What is the most common cause of euvolemic hyponatremia
SIADH
What are common precipitating causes of diabetic ketoacidosis?
Inadequate administration of insulin, undiagnosed/unknown diabetes, infection, pregnancy or stressors such as myocardial infarction, trauma, surgery, or substance abuse
Which group of medications should be avoided in the treatment of delirium tremens
Phenothiazines
They lower the seizure threshold, which can be a concern in patients with DTs who are already at risk of seizures
The use of high-dose insulin therapy in diabetics is associated with which emergent complications?
Hypoglycemia, hypokalemia, hypophosphatemia, ARDS and cerebral edema
What is the initial fluid of choice for resuscitation in hypotensive patient with hyperosmolar hyperglycemic state (HHS) until the patient is normotensive and electrolytes are stable?
Initial fluid replacement is with isotonic or normal saline
What are some neurologic findings associated with hyperosmolar hyperglycemic state (HHS)
Hemiparesis
Hemisensory deficits
Focal or grand mal seizures
Severe hypokalemia may be associated with which neurologic seuqelae
generalized weakness
Hyporeflexia
Paralysis
In the drug therapy of hyperkalemia, which treatment has the most rapid onset and the shortest duration of action?
Calcium gluconate or calcium chloride (onset 1-3 minutes, duration 30-50 min)
What is the most appropriate disposition for a patient taking a sulfonylurea who presents with drug-induced hypoglycemia?
Admission.
The long half-life of many of these drugs predisposes the patient to recurrent episodes until the drug is metabolized.
Chlorpropamide* has a half life of 36 hours with a duration of effect up to 2-5 days. Second generation drugs (glipizide, glyburide*, glimepiride) have much shorter half-lives but the duration of action ranges from 10-16 hours (glipizide) up to 24 hours (glyburide).
- knowledge of these two drugs is essential
What is the main contributor to the morbidity in untreated patients with diabetic ketoacidosis?
The main contributor to morbidity in untreated patients with diabetic ketoacidosis (DKA) is the development of severe metabolic derangements, which can lead to life-threatening complications such as hypotension, electrolyte imbalances, cerebral edema, and cardiac arrhythmias.
The severity of the acidosis is another important contributor to morbidity in patients with DKA.
Clinical presentation: a middle-aged female with history of type 1 diabetes mellitus presents with periorbital edema, chemosis, and dermopathy over the lower extremities.
What diagnosis should be suspected?
Graves’ disease, which is the most common cause of thyrotoxicosis
Which endocrinopathy may present with atrial fibrillation and congestive heart faiilure dominating the clinical picture?
Hyperthyroidism / thyrotoxicosis
How long after someone stops drinking can symptoms of alcohol withdrawal syndrome begin?
Mild symptoms such as tremulousness can start as early as 2 hours after cessation of drinking.
Seizures can occur as early as 6 hours, usually between 6-48 hours.
Hallucinations and psychosis begin between 12-48 hours.
What lab tests are helpful in the diagnosis of alcoholism
Hepatic transaminases
- AST>ALT suggests alcohol injury (ration >2)
- GGT is the most sensitive indicator of alcoholic liver damage
Increased mean corpuscular volume (MCV) is more specific of alcohol abuse than any of the transaminases
Carbohydrate-deficient transferrin (CDT) is the most specific and sensitive marker for heavy alcohol consumption
What is the treatment for Wernicke’s encephalopathy
Thiamine - administration of glucose prior to thiamine may theoretically precipitate Wernicke’s encephalopathy in patients with severe thiamine deficiency, though this has not been observed after single or repeat IV glucose boluses and this phenomenon is thought to be unlikely
Resistance to thiamine may occur secondary to hypomagnesemia (magnesium is a cofactor for thiamine transketolase)
Metabolic acidosis with high anion gap and high osmolar gap is suggestive of this ingestion
Toxic alcohols
As toxic alcohols metabolize, osmolar gap may decrease and normalize while anion gap increases
What is the main contributor to the mortality in untreated patients with DKA
Contributors to mortality of the pediatric population - cerebral edema, infection
For adults - infection, MI, retention
What are the indications for emergent correction of hyponatremia
Severe symptoms such as seizures, altered mental status / coma, or respiratory distress, which require immediate treatment.
Rapid onset of hyponatremia.
Hyponatremia in the setting of trauma or surgery (increased risk of cerebral edema)
What is the complication of overzealous treatment of hyponatremia?
Osmotic demyelination syndrome or central pontine myelinolysis - is an osmotic demyelination syndrome that develops due to a rapid correction of hyponatremia
The toxic alcohols cause both ketosis and acidosis with one exception. Which alcohol is the exception?
Isopropanol
Can have ketosis without acidosis
