DKA PBL Flashcards

1
Q

Normal ABG pH:

A

7.35-7.45

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2
Q

Normal ABG pCO2:

A

35-45 mmHg

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3
Q

Kussmaul respirations indicate?

A

Blowing off CO2

caused by high H+ (low pH), acidosis

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4
Q

How is anion gap calculated?

A

([Na+] - ([Cl-] + [HCO3-])

+’s minus -‘s

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5
Q

Normal anion gap?

A

8-12

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6
Q

high anion gap = ?

A

acidosis

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7
Q

low anion gap = ?

A

Multiple Myeloma

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8
Q

What is the Tm of SGLT-2’s?

A

15 mM glucose —> glucosuria

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9
Q

What drives K into cells via stimulation of Na-K-ATPase?

A

insulin

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10
Q

How does acidosis affect K transport and regulation?

A

HCO3 gets used up by excess H+ in serum

Extra H+ is pumped into cells and K+ gets kicked out

creating hyperkalemia

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11
Q

Why does K leave cells in hyperglycemia?

A

solvent drag

higher extracellular osmolality due to inc gluc draws water out and K in cell (which is high to begin with) follows through aquaporins

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12
Q

Why does K need to be monitors so carefully when correcting acidosis?

A

Intracellular hypokalemia exists despite serum hyperkalemia.

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13
Q

What do ketones in the urine have to do with excretion of K?

A

Ketones bind Na and K and are excreted as salts

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14
Q

What is the insulin dependent glucose transporter on skeletal and adipose tissue?

A

GLUT4

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15
Q

Lispro

A

Rapid acting insulin

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16
Q

Aspart

A

Rapid acting insulin

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17
Q

Glulisine

A

Rapid acting insulin

18
Q

Onset time for rapid acting insulin?

A

0.25 hours

15 min

19
Q

Peak time for rapid acting insulin?

A

0.5-1.5 hours

20
Q

Duration of rapid acting insulin?

21
Q

Onset time for short acting insulin?

A

0.5 hours

30 min

22
Q

Peak time for short acting insulin?

23
Q

Duration of short acting insulin?

24
Q

Onset time for intermediate acting insulin?

25
Peak time for intermediate acting insulin?
4-12 hours
26
Duration of intermediate acting insulin?
10-20 hours
27
Onset time for Long acting insulin?
1-2 hours
28
Peak time for long acting insulin?
none --- relatively flat
29
Duration for long acting insulin?
18-24 hours
30
"Regular" insulin
short acting IV tx to correct DKA
31
NPH
neutral protamine Hagerdorn or isophane intermediate acting insulin
32
glargine
long acting insulin
33
detemir
long acting insulin
34
Sx of DKA:
polyuria polydypsia polyphagia fatigue dyspnea (Kussmaul respirations) abd pain N/V HA confusion lethargy
35
Goal A1C fro diabetics:
36
Genes associated with Type I DM?
HLA-DR3 | HLA-DR4
37
Insulin receptor type?
growth factor R family (span membrane once) tyrosine kinase activators
38
Metabolic pathway of insulin signaling?
PI3-kinase --> serine/threonine kinase Akt --> GLUT4 vesicles to membrane * *increase glycogen and lipid synthesis * *stimulates protein synthesis via mTor
39
Mitogenic pathway of insulin signaling?
Ras --> phosphorylation cascade via MAP kinase --> cell growth and proliferation
40
Insulin increases a lot of stuff. What does it decrease?
glucagon release