Endo OME Flashcards by william hennrikus

headache, large fingers feet, htn diabetes, diastolic heart failure
think
workup

acromegaly

IGF1 (more sensitive than growth hormone)

then growth hormone / glucose suppresion test where GF fails to suppress

then MRI pituitary

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woman galactorhea amenorrhea elevated PRL sub-centimeter microadenoma on MRI
treat - where to start, where to go

start Dopamine Agonist like Bromocriptine or Cabergoline
even if some mild FNDs

escalate to resection if get refractory FNDs

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young woman asymptomatic hyponatremia jump straight to…

psychogenic polydipsia! Dra!

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central diabetes insipidus means, treatment

nephrogenic diabetes insipidus means, treatment

no ADH being made
give ddavp

no ADH Receptors in kidney
give furosemide for gentle diuresis more salt than water

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ddx for asymptomatic hypotonic hyponatremia

RATS
renal tubular acidosis
addison disease
thryoid disease
siadh

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old lady asymptomatic euvolemic hypotonic hyponatremia suggesting SIADH, next step correct hyponatremia or something else?

CT for lung cancer (small cell)
MRI brain for post pit tumor source would be next if chest CT negative

she is asymptomatic and euvolemic so no need to treat now… if coma or seizure give 3% hypertonic saline… anything less than that saline fluids will only make worse because will retain fluid but excrete sodium… only worsening condition… do probably Water Restrict, Salt Tablets, maybe anti-adh / blocker Demeclocycline… effectively inducing neprhogenic DI to treat SIADH… maybe limited use of 3%NS hypERtonic saline for Profound hyponatremia with Symptoms

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nephrogenic diabetes insipidus, think of 2 meds

Li (side effect, bipolar disorder)

Demeclocycline - induce nephrogenic DI (block ADH receptors) to treat SIADH (too much ADH)

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side effect of Buproprion and in what population

buproprion seizures in bulimics

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flushing, gi side effects, fever, myoclonus… side effects of what psyche drug?

serotonin syndrome

-sertraline, ssri’s

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reverse benzodiazepine overdose with this drug

flumazenil

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metformin associated with side effects of ___ on initiation, then ___ when comorbid renal failure

Diarrhea on admission, Metabolic Acidosis when renal failure

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ADH holds more __ and spills more __

ADH holds more water, spills more sodium

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desmopressin moa

increase ADH

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a1c^6.5, give metformin

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when to start insulin injections for diabetic

failure of oral meds

even if A1c is 15, start on orals if not already, and diet and exercise, give them a shot before insulin injections

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3 special health maintanence screenings for diabetics

peripheral neuropathy - monofilament / podiatry

retinopathy - annunal eye exams /ophtho

nephropathy - microalbuminuria/creatinine ratio

best screening test for patient at risk for diabetes

fasting glucose ^125 (on two occasions)
cheap, effective, sufficient - no confirmatory test required

not a1c… on the test, but in life sometimes

when is oggt used to screen for diabetes

fasting glucose positive ^125
but second is negative v125

then get ogtt

how high must blood sugar be for glucosuria to happen

180

tmax of glucose transporters in kidney

preferred 1st line for outpatient diabetes
contraindication
next up

METFORMIN 1st line
contraindicated in CKD (any Cr elevation)

next up GLIMEPIRIDE not contraindicated in ckd, just lower dose

a1c goal for diabetic

v7… but still treat (metformin) if ^6.5

Cr 1.5 in diabetic, 1st line glucose control drug?

not metformin… contraindicated in ckd (metabolic acidosis)

glimepiride - not contraindicated in ckd, just lower dose

why isn’t simple creatinine clearance or urine dipstick for protein used to screen for diabetic nephropathy?

Cr actually cleared early in DM because initial hyperfiltration… low clearance only in advanced disease

dipstick can only detect ^300mg/24hr MACROalbuminuria… ^30mg/24hr is abnormal

so RANDOM MICROALBUMINURIA/CREATININE RATIO is best screening test and convenient… vs 24hr urine collection for microalbuminuria… which is actually more accurate

type 1 diabetic on NPH bid and insulin with meals… her lunchtime sugars are high… how to adjust med regimen?

increase Breakfast Insulin

one meal before the high needs adjustment

metformin's basic moa

improve insulin sensitivity

TF | Glaaaargine is Looong acting insulin

true

type 1 diabetic on glaaaargine long acting qhs and prandial insulin has high breakfast sugars but normal at other meals and before bed, when checked at 3am glucose is low at 50. adjust regimen what if 3am glucose was high?

Decrease qhs glaargine dose -somogyi effect -- too much insulin at night causes hypoglycemia with rebound hyperglycemia in the morning... so reduce qHS insulin if high 3am and breakfast glucose then Dawn phenomena... liver producing glucose in sleep... so increase qHS insulin in that case

do not modify type 1 diabetes insulin regime if sugars are below ___

v130 don't touch

Lispor is __ acting insulin

Lispor is rapid acting insulin - prandial

Deeetemiiiir is a __ acting insulin like these others

Deeetemiiir is a Long acting insulin like Glaaargine and NNNNPPPHHH

Metformin and Glyburide depend on a funcitonal ___

Metformin and Glyburide depend on a funcitonal Pancreas -- met enhances insulin sensitivity and glyburide pushes out more insulin from the pancreas

ketosis and acidosis =

DKA

why never intubate DKA (unless hypoxemic from another cause like pneumonia or something)

body can blow off more CO2 without added dead space of a ventilator

mannitol is used to

mannitol used to increase intracerebral pressures

``` HHNKC/HHS stands for why no ketones why hyperosmolar why no acidosis why coma how treat ```

Hyperglycemic Hyperosmolar NonKetotic Coma / Hyperglycemic Hyperosmolar State no ketones because sufficient insulin to feed the brain (t2dm not t1dm like dka) hyperosmolar because glucose up (may suppress sodium) no acidosis because not accessing fatty acids coma because profound dehydration -- hyperglycemia -- diuresis...? treat with Fluids and IV Insulin Intubate FIRST if indicated by hypoxia (acidosis not a concern like DKA) follow Symptomatic improvement (instead of AGAP in DKA)

acid base distrubance in opiate overdose

hypoxemic hypercapnic respiratory alkalosis

coma cocktail given by ems

naloxone (opiate overdose) thiamine (...) D5 (hypoglyemia) can help for common coma causes but won't hurt