Endo & Renal

Question 1

DKA Management

Answer 1

1. 1L fluid bolus, 500cc/hr for 4 hrs, 250cc/hr 4hrs
2. check K+, if <3.3 give 40mmol/l and if 3.3-5 do 10-40/1L
3. once K > 3.3, start insulin infusion 0.1U/kg/hr
4. if pH<7, consider NaHCO3
5. once glucose 14 add D5W to fluids to maintain BG 12-14
6. Calculate corrected Na - if high switch to 0.45% NaCl, if low continue 0.9%
7. Monitor blood glucose, electrolytes and VBG hourly

Question 2

DKA Precipitants

Answer 2

7 I’s of DKA & HHS:
1. initial dx
2. infection (pneumonia, UTI, etc)
3. ischemia (MI/CVA/ischemic bowel/critical limb)
4. insulin missed
5. intoxication (ETOH, MDMA, cocaine)
6. iatrogenic (steroids & surgeries)
7. impregnantion

Question 3

Blood sugar targets in DM

Answer 3

HBA1c < 7
Fasting sugar 4-6
BP < 130/80
LDL < 2
TG < 1.5
TC/HDL < 4

DM:
HBA1c > 7
Fasting sugar > 7
Random glu + sx > 10
GTT > 11.1

Pre-DM:
Fasting sugar 6.1 - 6.9
GTT 7.8 - 11

Question 4

DM diagnosis

Answer 4

DM:
HBA1c > 6.5%
Fasting sugar > 7
Random glu + sx > 10
GTT > 11.1

Pre-DM:
Fasting sugar 6.1 - 6.9
GTT 7.8 - 11

Question 5

Pre-DM diagnosis

Answer 5

Pre-DM:
HbA1c 5.8 - 6.4%
Fasting sugar 6.1 - 6.9
GTT 7.8 - 11

DM:
HBA1c > 6.5%
Fasting sugar > 7
Random glu + sx > 10
GTT > 11.1

Question 6

Normal blood sugar

Answer 6

HBA1c <5.7%
Fasting sugar 3.9 - 5.5