DKA PBL Flashcards
Normal ABG pH:
7.35-7.45
Normal ABG pCO2:
35-45 mmHg
Kussmaul respirations indicate?
Blowing off CO2
caused by high H+ (low pH), acidosis
How is anion gap calculated?
([Na+] - ([Cl-] + [HCO3-])
+’s minus -‘s
Normal anion gap?
8-12
high anion gap = ?
acidosis
low anion gap = ?
Multiple Myeloma
What is the Tm of SGLT-2’s?
15 mM glucose —> glucosuria
What drives K into cells via stimulation of Na-K-ATPase?
insulin
How does acidosis affect K transport and regulation?
HCO3 gets used up by excess H+ in serum
Extra H+ is pumped into cells and K+ gets kicked out
creating hyperkalemia
Why does K leave cells in hyperglycemia?
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
Why does K need to be monitors so carefully when correcting acidosis?
Intracellular hypokalemia exists despite serum hyperkalemia.
What do ketones in the urine have to do with excretion of K?
Ketones bind Na and K and are excreted as salts
What is the insulin dependent glucose transporter on skeletal and adipose tissue?
GLUT4
Lispro
Rapid acting insulin
Aspart
Rapid acting insulin
Glulisine
Rapid acting insulin
Onset time for rapid acting insulin?
0.25 hours
15 min
Peak time for rapid acting insulin?
0.5-1.5 hours
Duration of rapid acting insulin?
3-4 hours
Onset time for short acting insulin?
0.5 hours
30 min
Peak time for short acting insulin?
2-3 hours
Duration of short acting insulin?
4-8 hours
Onset time for intermediate acting insulin?
2-4 hours
Peak time for intermediate acting insulin?
4-12 hours
Duration of intermediate acting insulin?
10-20 hours
Onset time for Long acting insulin?
1-2 hours
Peak time for long acting insulin?
none — relatively flat
Duration for long acting insulin?
18-24 hours
“Regular” insulin
short acting
IV tx to correct DKA
NPH
neutral protamine Hagerdorn or isophane
intermediate acting insulin
glargine
long acting insulin
detemir
long acting insulin
Sx of DKA:
polyuria
polydypsia
polyphagia
fatigue
dyspnea (Kussmaul respirations)
abd pain
N/V
HA
confusion
lethargy
Goal A1C fro diabetics:
Genes associated with Type I DM?
HLA-DR3
HLA-DR4
Insulin receptor type?
growth factor R family (span membrane once)
tyrosine kinase activators
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
Mitogenic pathway of insulin signaling?
Ras –> phosphorylation cascade via MAP kinase –> cell growth and proliferation
Insulin increases a lot of stuff. What does it decrease?
glucagon release
