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Preresidency > DKA > Flashcards

DKA Flashcards

1
Q

How does sodium decrease in relation to glucose?

A

Every 100 glucose increase is 1.6 Na decrease

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2
Q

Why do ketone levels elevate with resolution?

A

Nitroprusside test detects acetoacetate and acetate. More is formed towards resolution.

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3
Q

Fluid replacement regimen

A

2 to 3 L first 3 hours (10 to 20 ml/kg/hr) pNSS
250to 500 mL per hour 0.45NSS
150 to 250 mL per hour D50.45NSS once glucose 250

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4
Q

Insulin dose

A
  1. 1 U/kg then 0.1U/kg/hr as drip

0. 02 to 0.1 U/kg/hr once CBG 200 to 250 and add glucose

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5
Q

Cut off for bicarbonate

A

PH < 7.0

50 mmol HCO3 in 100 mL with 10 meq Kl

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6
Q

Cut off for phosphate supplementation

A

Phosphate less than 0.32

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7
Q

Hydration in HHS

A

9 to 10 L replaced in 1 to 2 days.
200 to 300 mL per hour of hypotonic solution
0.45 NSS then D5W

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8
Q

Glycemic goals for hospitalized patients

A

140 to 180 in critically ill

110 to 140 in selected patients

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9
Q

What to remember before discontinuing insulin IV

A

Overlap 2 to 4 hours with long acting insulin

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10
Q

Insulin adjustment for individuals

A

1U per 50 mg/dL for thin

2U per 50 mg/dL for fat

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11
Q

TPN and insulin

A

TPN increases insulin requirements

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12
Q

Steroids and diabetes

A

Steroid-induced diabetes due to decreased glucose utilization.
Oral agents if less than 200.

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13
Q

Reproductive capacity in people with DM

A

Normal

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14
Q

Glucose is a (blank) at high doses in pregnancy?

A

Teratogen

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15
Q

Oral hypoglycemics in pregnancy

A

Glyburide and metformin

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16
Q

Risk for fetal malformations in pregnant DM is?

A

4 to 10x a normal individual

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17
Q

Pathophysiology of lipodystrophy DM

A

Decreased leptin and increased insulin resistance with acanthosis nigricans, hypertriglyceridemia and hepatic steatosis

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18
Q

Leading contributor to CHD

A

Diabetes

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19
Q

Microvascular DM complications

A

Retinopathy, neuropathy, and nephropathy

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20
Q

Macrovascular complications of DM

A

CHD
PAD
CVD

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21
Q

CHD rate increased by this much if you have DM

A

2 to 4 times

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22
Q

Trial comparing standard and intensive glycemic control in diabetes

A

Diabetes Control and Complications Trial

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23
Q

Results of DCCT

A

HbA1c 7.3% intensive
9.1% conventional

Intensive higher risk of hypoglycemia and weight gain

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24
Q

Follow up of 30 years after DCCT

A

Epidemiology of Diabetes Intervention and Complications or EDIC

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25
Q

More than 5000 individuals with more than 10 years of DM

A

UK Prospective Diabetes Study

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26
Q

Comparison groups in UKPDS

A

Insulin, SU and metformin vs. conventional

27
Q

UKPDS HbA1c microvascular complication reduction

A

1 unit HbA1c to 35% risk reduction

28
Q

UKPDS BP guidelines

A

Reduce moderately to lower micro and macrovascular rates

29
Q

Japanese study showing reduced microvascular complications

A

Kumamoto study

30
Q

Phenomenon where early glycemic control affects later life

A

Metabolic memory or legacy effect

31
Q

Hypothesis for DM complications

A
  1. Epigenetic
  2. Advance glycosylation end products (pentosidine, glucosapene and carboxymethyllysine)
  3. Aldose reductase sorbitol pathway
  4. Diacylglycerol-fibronectin
  5. Altered glycosylation of proteins
32
Q

Features of nonproliferative DR

A

Retinal microaneurysms
Blot hemorrhages
Cotton wool spots

33
Q

Hallmark of PDR

A

Neovascularization

34
Q

Predictors of retinopathy in DM

A

Duration of DM

Degree of glycemic control

35
Q

Most effective treatment for DRet?

A

Prevention

36
Q

DRet may transiently worsen in first (blank) of glycemic control

A

6 to 12 months

37
Q

Drug that reduces progression of retinopathy

A

Fenofibrate

38
Q

Recommendation for eye exam in diabetics

A

Routine undilated eye exam not recommended. Refer to Ophtha.

39
Q

Aspirin and DRet

A

No effect

40
Q

Leading cause of CKD, ESRD

A

DNeph

41
Q

Associated with increased risk of CVD in DM patients

A

Albuminuria

42
Q

Risk factors for DNeph

A

Family history and race

43
Q

First years of DNeph

A

Glomerular hyperperfusion and renal hypertrophy with increased GFR

44
Q

Define albuminuria

A

Spot albumin to creatinine ratio > 30 mg/g

45
Q

GFR cut-off for DNeph

A

60

46
Q

Type 2 DM neohropathy differences with type 1

A
  1. Albuminuria on diagnosis
  2. Hypertension
  3. Less association with albuminuria
  4. Albuminuria from HTN, CHF, prostate disease or infection
47
Q

Screening for albuminuria

A

Five years after DM1

Immediately after DM2

48
Q

Optimal therapy for diabetic nephropathy

A

Prevention

49
Q

Slowing progression of albuminuria by

A
  1. Glycemic control
  2. BP control
  3. ACEI or ARB
50
Q

Glucose medications contraindicated in ESRD

A

Metformin

Sulfonylureas

51
Q

BP targets for DNeph

A

<140/90 diabetics

<130/80 risk for CVD or CKD progression

52
Q

When to refer DNeph to renal

A

GFR less than 30 and albuminuria

53
Q

Referral for transplant in DNeph patient

A

GFR < 20

54
Q

Leading cause of death in diabetics with nephropathy and hyperlipidemia

A

Complications of atherosclerosis

55
Q

Hypotension in DNeph patients

A

Autonomic nephropathy loss of reflex tachycardia
Difficult vascular access
retinopathy

56
Q

Type of neuropathy in DM

A

Distal symmetric polyneuropathy

57
Q

Risk factors for DNeuro

A 
BMI
Smoking
Duration
Glycemic control
CVD
Elevated TG
HTN
58
Q

Most common DNeuro

A

Distal symmetric polyneuropathy

59
Q

Character of distal symmetric polyneuropathy

A 
Lower extremities
At rest
At night
Pain
Loss of ankle tendon reflezes
Abnormal position sense 
Foot drop
60
Q

Aim of DNeuro screening

A

Identify loss of protective sensation

61
Q

Features of cardiovascular autonomic neuropathy

A

Decreased heart rate variability
resting tachycardia
Orthostatic hypotension
Sudden death

62
Q

Other autonomic problems of DM

A 
Gastroparesis
Bladder emptying
Hyperhidrosis of UE
Anhidrosis of LE
Hypoglycemia unawareness due to counterregulatory hormone release
63
Q

Most common mononeuropathy of DM

A

Third CN diplopia with ptosis and ophthalmoplegia

Preresidency (17 decks)

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