Endo Flashcards
Metformin
Check liver or kidney problems
GI problems usually resolve
Can weight loss, B12 deficiency (tired, breathless, faint, tingling)
Lactic acidosis (tired, nausea, vomiting, pain, fever)
Take with food to reduce GI effects
If still SEs try MR metformin
Annual eGFR check
Hypoglycaemia
Hypo = less than 3.9
A to E approach
2 tubes glucose 40% gel
1g IM glucagon if too drowsy
IV glucose 20%, 100ml over 15 min
Causes - hypopituitarism, Addison’s, insulinoma, alcohol
DKA
F - Fluids (1L 0.9% saline over 1 hour)
I - Insulin (Fixed rate 0.1u/kg/hr)
G - Monitor glucose
P - Monitor / give potassium
I - Treat underlying infections / triggers
C - Monitor for cerebral oedema
K - Monitor ketones & pH
DKA resolution
pH >7.3 and
blood ketones < 0.6 mmol/L and
bicarbonate > 15.0mmol/L
if not resolved in 24h refer to specialist
HbA1c targets, diabetes drug order
48mmol target if lifestyle (+ metformin) - but 2nd drug if reached 58mmol
53mmol target if hypo drug
Usually metformin > dapagliflozin if CVD > gliptin/gliclazide/pioglitazone
if triple therapy ineffective start insulin
Diabetes diagnosis
If symptomatic:
fasting glucose >7, random glucose >11
If asymptomatic, need 2 tests
Beware if haemoglobinopathy, severe anaemia, blood transfusion
Diabetic foot
Ulcers, peripheral neuropathy, infection/ inflammation
Acromegaly
Usually GH secretion by pituitary adenoma
Facial features coarsen, soft tissue hypertrophy, joint pain, carpal tunnel
Investigate with IGF-1, pituitary MRI and consider OGTT
1) trans-sphenoidal surgery, 2) somatostatin analogue (ocreotide) or growth hormone receptor antagonist
Hyperthyroidism
Overproduction of T3 and T4, often due to Graves’ (TSH receptor antibodies bind to receptors, stimulate production)
Causes anxiety, sweating, tachy, weight loss, palps, tremor, goitre, exoph
do TFTs, consider scintigraphy/USS
1) carbimazole, consider propranrolol, radioactive iodine, thyroid surgery
Hypercalcemia
hyperparathyroidism - PTH increases Ca resorption to reduce urine excretion
usually primary due to adenoma
malignancy - either bony tumour w/ osteoclast activity or secretes PTHrP
other causes - hyperthyroidism, high Ca intake, Paget’s, lithium, thiazides
