DKA PBL

Question 1

Normal ABG pH:

Answer 1

7.35-7.45

Question 2

Normal ABG pCO2:

Answer 2

35-45 mmHg

Question 3

Kussmaul respirations indicate?

Answer 3

Blowing off CO2

caused by high H+ (low pH), acidosis

Question 4

How is anion gap calculated?

Answer 4

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

+’s minus -‘s

Question 5

Normal anion gap?

Answer 5

8-12

Question 6

high anion gap = ?

Answer 6

acidosis

Question 7

low anion gap = ?

Answer 7

Multiple Myeloma

Question 8

What is the Tm of SGLT-2’s?

Answer 8

15 mM glucose —> glucosuria

Question 9

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

Answer 9

insulin

Question 10

How does acidosis affect K transport and regulation?

Answer 10

HCO3 gets used up by excess H+ in serum

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

creating hyperkalemia

Question 11

Why does K leave cells in hyperglycemia?

Answer 11

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

Question 12

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

Answer 12

Intracellular hypokalemia exists despite serum hyperkalemia.

Question 13

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

Answer 13

Ketones bind Na and K and are excreted as salts

Question 14

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

Answer 14

GLUT4

Question 15

Lispro

Answer 15

Rapid acting insulin

Question 16

Aspart

Answer 16

Rapid acting insulin

Question 17

Glulisine

Answer 17

Rapid acting insulin

Question 18

Onset time for rapid acting insulin?

Answer 18

0.25 hours

15 min

Question 19

Peak time for rapid acting insulin?

Answer 19

0.5-1.5 hours

Question 20

Duration of rapid acting insulin?

Answer 20

3-4 hours

Question 21

Onset time for short acting insulin?

Answer 21

0.5 hours

30 min

Question 22

Peak time for short acting insulin?

Answer 22

2-3 hours

Question 23

Duration of short acting insulin?

Answer 23

4-8 hours

Question 24

Onset time for intermediate acting insulin?

Answer 24

2-4 hours

Question 25

Peak time for intermediate acting insulin?

Answer 25

4-12 hours

Question 26

Duration of intermediate acting insulin?

Answer 26

10-20 hours

Question 27

Onset time for Long acting insulin?

Answer 27

1-2 hours

Question 28

Peak time for long acting insulin?

Answer 28

none — relatively flat

Question 29

Duration for long acting insulin?

Answer 29

18-24 hours

Question 30

“Regular” insulin

Answer 30

short acting

IV tx to correct DKA

Question 31

NPH

Answer 31

neutral protamine Hagerdorn or isophane

intermediate acting insulin

Question 32

glargine

Answer 32

long acting insulin

Question 33

detemir

Answer 33

long acting insulin

Question 34

Sx of DKA:

Answer 34

polyuria

polydypsia

polyphagia

fatigue

dyspnea (Kussmaul respirations)

abd pain

N/V

HA

confusion

lethargy

Question 35

Goal A1C fro diabetics:

Question 36

Genes associated with Type I DM?

Answer 36

HLA-DR3

HLA-DR4

Question 37

Insulin receptor type?

Answer 37

growth factor R family (span membrane once)

tyrosine kinase activators

Question 38

Metabolic pathway of insulin signaling?

Answer 38

PI3-kinase –> serine/threonine kinase Akt –> GLUT4 vesicles to membrane

• *increase glycogen and lipid synthesis
• *stimulates protein synthesis via mTor

Question 39

Mitogenic pathway of insulin signaling?

Answer 39

Ras –> phosphorylation cascade via MAP kinase –> cell growth and proliferation

Question 40

Insulin increases a lot of stuff. What does it decrease?

Answer 40

glucagon release