Endocrine Flashcards
What is found in 80% of pts with DMI?
Antibodies against GAD-65
Ketone development is seen in which type of DM?
Type I
A serum fasting (at least 8 hours) blood glucose of what or above on more than one occasion is diagnostic for DM?
126
An A1C of what or above is diagnostic for DM?
6.5%
What is the optimal insulin regimen?
A basal insulin plus a mealtime bolus of rapid or short acting insulin
What occurs with the Somogyi effect?
The pt will be hypoglycemic at 3am but have rebound hyperglycemia at 7am
How do you treat the Somogyi effect?
Reduce or omit bedtime dose of insulin
What occurs with the Dawn phenomenon?
Blood glucose becomes progressively elevated throughout the night, with resulting elevated BS at 7am
How do you prevent Dawn phenomenon?
Add or increase bedtime dose of insulin
What are the three components of Syndrome X?
Obesity, HTN and abnormal lipid profiles
Waist circumference is equal to or above what in metabolic syndrome?
Above 40 inches in men and above 35 inches in women
BP is above or equal to what in metabolic syndrome?
Above 135/85
Triglycerides are equal to or above what in metabolic syndrome?
150
Fasting BG is equal to or above what in metabolic syndrome?
100
HDL is below what in metabolic syndrome?
Below 40 in men and below 50 in women
Will you see ketones in the blood or urine in DMII?
No
What is the starter drug of choice in DMII?
Metformin
What is the major potential complication of metformin?
Lactic acidosis
What is the second line therapy class of drugs for DMII?
GLP-1 agonist
What are two potential complications of GLP-1 agonists?
Thyroid CA and pancreatitis
What is the dosing for insulin for DKA?
0.1 units/kg as a bolus followed by 0.1 units/kg/hr drip
What is the most common presentation of hyperthyroidism?
Grave’s disease
In a hyperthyroid pt, what happens to TSH and T3?
TSH is low and T3 is high
What med is given for symptomatic management in hyperthyroid?
Propranalol
What is the most common cause of hypothyroidism?
Hashimoto’s
What thyroid labs are seen in hypothyroidism?
Elevated TSH and low T4
What symptom may occur when starting synthroid?
Hair loss
What should you avoid in thyroid crisis?
Aspirin
What is Cushing’s?
ACTH hypersecretion
What happens to BP in Cushing’s?
Will be elevated
What happens to the distribution of fat in Cushing’s?
Moves from the extremities to a more central distribution
What are three major electrolyte disturbances in Cushing’s?
Hyperglycemia, hypernatremia, hypokalemia
What is Addison’s disease a deficiency of?
Cortisol, androgens and aldosterone
How is Addison’s managed?
With glucocoticoid and mineralocorticoid replacement
What three lab abnormalities are seen in Addison’s?
Hypoglycemia, hyponatremia, hyperkalemia
What is a cosyntropin stimulation test used to rule out?
Addison’s disease
What does SIADH cause?
Inappropriate water retention
Neuro changes in SIADH are 2/2 what?
Hyponatremia
What will pt with SIADH’s fluid status be?
Euvolemic
What is serum os in SIADH?
<280
What is urine os in SIADH?
> 100
What is urine sodium in SIADH?
> 20 mEq/L
How to manage SIADH if serum Na+ > 120?
Restrict total fluids to 1L/ 24 hours
How to manage SIADH if serum Na+ 110-120 w/o neuro changes?
Restrict total fluids to 500mL/ 24 hours
How to manage SIADH if serum Na+ <110 or neuro sx are present?
Replace with isotonic or hypertonic saline and Lasix
What is diabetes insipidus?
Inadequate output of or kidney response to ADH
Difference between SIADH and DI?
SIADH=too much ADH; DI=not enough ADH
What are the main sx of DI?
Water craving and polyuria
What happens to sodium in DI?
Will see hypernatremia
What is a normal BUN?
10-20
What is a normal Cr?
0.5-1.5
What is normal urine specific gravity?
1.010-1.03
What is used to treat acute DI?
DDAVP
For a pt being discharged with DI, what is the maintenance dose of DDAVP?
10 ug q 12-24 hours IN
What four things are on a urine assay test for pheochromocytoma?
Urine catecholamines, metanephrines, VMA and creatinine
How do you confirm diagnosis of a pheochromocytoma?
CT scan
What should you watch for after removal of a pheochromocytoma?
Hypotension
