endo Flashcards
diabetic neuropathy
glycosolation of small blood vessels supplying nerves causes blood flow disruption. nerve dysfunction/ death.
most common chronic complication of diabetes.
pain or asymptomatic usually.
S+S: distal symmetrical. hands feet.
constipation, dry skin, anhydrosis, autonomic dysfunction, faecal incontinence.
asymptomatic MI- other small nerves going.
Rf: poorly controlled hyperglycaemia.
older, tall, HTN, inc triglycerides.
Ix: clinical diagnosis but consider blood sugar measuring- hba1c
Rx:
glycaemic control +
1st pregabalin/ gabapentin/ duloxetine/ amytriptaline.
2nd: antidepressant / sodum chanel blocker
3rd: topical capsaicin or gtn.
gestational diabetes
5.6 fasting 7.8 OGTT.
makes big fat babies
increaces chances of pre-ecclampsia, depression, needing a C section.
recognised often at 24-28 weeks
S+S: polyuria, polydipsia,
Rf: prev gesty debs, overweight, FHT2DM, PCOS.
Rx:
if 6.0 or higher at fasting glucose + big baby or fasting above 7— insulin- 1unit/kg/day roughly.
consider metformin
normally consider lifestyle factors + metformin + insulin if needed.
hyperosmolar hyperglycaemic state
a state where glucose if very high in the blood stream (grey book >33)
glucose draws water from tissues into blood
loose lots of water through urine due to inability to return all glucose to blood stream from urine.
generally not ketotic.
brain wil make osmotically active osmoles- so re-hydration too quickly can result in cerebral edema.
S+S: hypotension, tacy, reduced consiousness,
can become acidodic due to AKI.
Rx: 2 large cannula. FBC.
1L 0.9% NaCl over 1 hr. add 20mm K if <5.5.
further fluids 500m/hr hr 2
100-200ml/hr .
aim to reduce serum osmolality between 3-8 an hour.
keep gluc between 10-15 in first 24 hours.
management of hypoglycaemia
most common cause is hypoglycaemic drugs or DM. occ suicide ODs have the same effect.
4mm- mild (tremble, sweat, tingle, anxiety, headache, nausea) - 15-20g glucose (tabs, juice)
2-3- moderate- consious + able to swallow- needs assistance (diff speaking, walking, confused, drowsy) – glucojuice
if non coop- 2x tubes of glucogel (needs gag reflex)
1- severe - pt unconsiouss— check airway, revocery pstn, stop insulin infusion.
100mls 10% glucose IV.
OR 1mg glucagon IM.
repeat if no imprvement.
if still no improvement 10% glucose at 100ml/hr– but check for other causes of unconsiousness.
IF on sulphonylurea- consider octreotide 50mg per 12hr.
follow up with a good starchy meal. never omit insulin follwoing episode unless severe.
diabetes in pregnancy
not much to do really- make sure control is as good as can get it.
dont get pregnant if hba1c is 86 or higher. - significant risks.
cant use ACEi or ANG antags - use alternatives.
offer retinal assessment + renal assessment.
target blood levels- fasting 5.3
1hr post meal 7.8
2hr 6.4
hbac1 in 2nd and 3rd tris is no good.
meds: rapid acting analogues (aspart/ lispro) are slightly better than human analouge.
SIADH
excessive Anti-diuretic hormone released either from post pituitary or other source.
excessive solute free absorption from the urine.
leads to- hypotonic hyponatraemia- euvolaemic.
S+S: concentrated urine, anorexia, seizure, coma, vom.
causes: cancer- ectopc prod. meds, CNS disorders (sub-arac etc)
Ix: bloods, osmolality (serum + urine– compare), urine sodium.
