Endo

Question 0

3 diagnostic criteria for diabetes

Answer 0

1. Fasting (8 hrs) glucose of 126 or >
2. Casual glucose >200 and symptoms of polydipsia, polyuria and unintentional weight loss
3. HgbA1c >6.5
4. 2hr OG tolerance test > or = 200

Question 1

Define pre diabetes

Answer 1

Fasting glucose of 100-125

Question 2

Calculated Osmolarity

Answer 2

2xNa + (glu/18) + (BUN/2.8) +
[(ethanol/4.6) + (methanol/2.6) + (ethylene glycol/5) + (acetone/5.5) + (isopropanol/5.9)]

Normal = 275-295

Question 3

DKA: diagnostic criteria

Answer 3

Glucose >250
AG >10
Bicarbonate <7.3 with moderate Ketonemia

Question 4

In DKA: 3.3 < [K+] <5.3

Answer 4

10 mEq/hr x4 hrs (first 4)

or 20-40mEq in ea 1 L bag after K+ goal [K+] = 4-5

Measure K q2H

Question 5

How should DKA be treated?

Answer 5

1. Fluids - fluid deficit us. 5-10L
   Give 2L NS in first 2 hours
   Then 2L over next 2-6H
   Then 2L more over next 6-12H

In kids give 10-20 ml/kg/hr repeated once
Do not exceed 50 mls/kg IV fluids in first hour
Admin fluids at 1.5x maintenance x24 hrs

2. Check lytes
3. K+ replacement: 20-40 mEq per 1LNS
4. Insulin if K >3.3
5. After Insulin < 250 switch to D5-1/2NS
6. Mg and Ca as needed

Question 6

Insulin replacement in DKA

Answer 6

Do not start insulin before checking a K+

0.1 U/kg/hr via IV infusion
Goal dropping glucose by 50-75 mg/dL/hr

Question 7

Sodium correction in hyperglycemia

Answer 7

Hyperglycemia causes water to shift extracellularly resulting in true hyponatremia (not pseudohyponatremia)

Na falls 1.6 mEq/L for every 100 mg/dL increase of glucose above 100 mg/dL

Question 8

Pseudohyponatremia

Answer 8

Artifact
Occurs in setting of hyperproteinemia ie multiple myeloma
Or in hypertriglyceridemia

Question 9

Hypercalcemia: tx

Answer 9

IV fluids
Loop diuretics ie Lasix
Avoid thiazides diuretics which will further increase the Ca

Pharmacotherapy includes: calcitonin, hydrocortisone, bisphosphonates
Consider dialysis in renal failure pts who cannot tolerate aggresssive IV fluid hydration

Question 10

Alcoholic keto acidosis

Answer 10

Significant elevations of beta hydroxy butyrate is the most specific marker AKA

Question 11

Vitamin A toxicity

Answer 11

Intracranial HTN, headache, visual deficits, 6th nerve palsy, hepatotoxicity, hypercalcemia

Fat soluble vitamins (A, D, E, and K) except vit K are assoc with toxicity in overdose