diabetes cpc Flashcards
definition of dm
fastibng glucose >7
HbA1c >48
2hr fasting glucose in a GTT >11.1
what is the 1st test needed
ABG
what disturbance is this
metabolic alkalosis
pH is high - alkalosis
CO2 is high
high bicarb
how do you determine whether acidosis/alkalosis
causes of metabolic alkalosis
H+ loss - eg from vomiting
hypokalaemia
ingestion of bicarb - Used to have sodium bicarb for peptic ulcer
describe resp compensation for metabolic alkalosis
met alkalosis inhibits breathing -> CO 2 rise -> partial compensation
Compensation is the improvement of pH at expense of making CO2 worse
calculation for osmolality
osmolality = 2(Na + K) + U + glucose
381 mosm/kg
calculation for the anion gap
Na + K - Cl - bicarb
if no anion gap can it be DKA
no - ketones are anions and would -> high anion gap
causes of hypokalaemia
intesinal loss - diarrhoea, vomiting, fistula
renal loss - mineralocorticoid excess (conn’s syndrome), diuretics, renal tubular disease
redistribution - insulin, alkalosis
causes of hypokalaemia
intesinal loss - diarrhoea, vomiting, fistula
renal loss - mineralocorticoid excess (conn’s syndrome), diuretics, renal tubular disease
redistribution - insulin, alkalosis
how does hypokalaemia lead to alkalosis
low K means shift H into cells
-> extracellular alkalsis
how does alkalosis -> low K
more K moves into the cells instead of H
causes of hypokalaemia
GI loss - diarrhoea, vomiting
renal loss
* hyperaldosteronism, excess cortisol
* increased Na delivery to distal nephron
* osmotic diuresis
redistribution into cells
* insulin
* B agonists
* alkalosis
rare causes - renal tubular acidosis type 1 and 2, hypomagnesaemia
pathophysiology in kidney of low K causing alkalosis
lack of intracellular K
-> increased excretion of H+ in exchange fro Na
-> acid urine and generaton of bicarb
cushings
which is the likely dx
Adrenal tumour not possible - suppress ACTH
And here she has high ACTH
Ectopic slightly more than pit because so high - but both ACTH driven ones are possible
why does ectopic ACTH -> such low K
High ACTH gives high cortisol binds to aldo receptor
causes of ectopic acth
lung cancer
other cancer
Collapse and consolidation
All given by increased vocal resonance
Pneumonia - peculiar distribution
Airway pulled to R - small endobronchial lesion -> collapse and consolidation, likely to be a cancer
how do we distinguish acute renal failure (ATN) and chronic renal failure due to dm
biopsy
diff in px between acute renal failure (ATN) and chronic renal failure due to dm
ATN - dialyse for 3 wks - recover
diabetic glomerular kidney disease - end stage renal failure, will need lifelong dialysis
