Endo CIS Flashcards
Polydipsia
-prolonged excessive thirst
Polyuria
-excessive urination
polyphagia
-my life
kussmaul respirations
-deep rapid respirations associate with acidosis
DDx of Anion Gap metabolic acidosis
MUDPILES
- Methanol
- Uremia
- Diabetes
- Paraldehyde
- Infection/Iron
- Lactic Acidosis
- Ethylene glycol
- Salicylates
How do you calculate anion Gap
Na- (Cl+HCO3)
-so, just take the positive ions (except potassium) and the negative ions and put them together!
GI ddx of abdominal pain
- GERD
- Gastritis
- PUD
- Obstruction of small or large bowel
- Inflammation
- Infectious
- Vascular
GU ddx for abdominal pain
-Renal lithiasis
-blocked or torsed ureter, testicular torsion
-
Toxic causes of abdominal pain?
-Black widow spider bit
Metabolic causes of abdominal pain
- Uremia
- Hyperlipidemia
- DKA!!! (this was the Diagnosis!!)
What was under DKA as a description?
- Kussmaul breathing
- unintentional wt loss over last 2 months
- polyuria
- polydipsia
- polyphagia
- hyperglycemia
- positive ketones in urine and blood
- low pH with anion gap
Where do we admit a patient with DKA?
-the ICU
What is the most important treatment for this diagnosis?
- IV fluids
- FLUIDS/FLUIDS/FLUIDS-DEHYDRATED GIVE THEM FUCKING FLUIDS
What electrolyte do we have to watch when replenishing fluids?
- K+
- initially, this is elevated, but when we give insulin/IVF, that will drive K+ into cells and they become hypokalemic
How do we correct the sodium when sugar is high?
-Na + ((glucose-100)* 0.016)
For fluid replacement, what do we use initially?
-Normal saline
What do we have to swith to when the patient on insulin gtt when their glucose gets to 250 to prevent hypoglycemia?
-switch to D5 1/5 NS
What is the goal of treatment of DKA?
- Fix acid base disturbance!!
- do NOT answer bring sugar to normal level
Why does the sugar level not matter as much to us in DKA?-
-they can have a “normal” sugar and still have an anion gap acidosis, they will go right back into DKA if you stop too soon
What were the other notable findings/concerns for this diagnosis in this patient?
-DKA: diffuse abdominal pain, fruity breath, unintentional weight loss, ketonuria, hyperglycemia
When can you end the protocol for DKA tx?
- when dat gap is closed
- switch to SQ insulin, stop gtt (glucose tolerance test) 2 hours after administration of SQ long acting (they will go right back into DKA if you stop too soon)
Chapman point of the pancreas
-R 7th intercostal space tissue texture changes
Sympathetics of pancreas
-T5-9
Parasympathetics of pancreas
- OA E RLSR
- AA RR
When should we do OMM on the DKA patient?
-after they have stabilized
Sympathetics of the pancreas and kidneys
- Pancreas: T5-9 on R or B/l
- Kidneys: T9-L1 on R
Parasymp of pancreas and kidneys
-both OA and AA
Chapmans points for pancreas
-Right 7th intercostal space
Chapman’s point for kidneys?
-1’ superior and 1’ lateral to the umbilicus
What does the right lymphatic duct drain?
- the right head and neck, right UE, all lung lobes except upper left
- the rest is drained by the thoracic duct
Sequence of lymphatic tx?
- Thoracic inlet
- Thoracic area
- Abdominal area
- UE or LE depending on which is more dysfunctional
- UE or LE
- Head and NEck
- Thoracic inlet…. kind of a weird circle around the body
