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ACVIM General - Imp stuff > Endocrine > Flashcards

Endocrine Flashcards

1
Q

What does the posterior pituitary secrete?

A

Oxytocin
ADH

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2
Q

What does the anterior pituitary secrete?

A
  1. GH
  2. FSH
  3. LH
  4. TSH
  5. ACTH
  6. Prolactin
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3
Q

What’s the difference between inactive and active thyroid cells?

A

Inactive: more colloid, flatter cells, epithelial cells
Active: less colloid, fatter cells, cuboidal cells, reabsorbed lacunae

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4
Q

What are the steps for thyroid hormone production and synthesis?

A
  1. Iodine trapping: IoDide is moved into the cell via NaI transport (iodine pump) –> Iodine in the cell
    Enzyme responsible: thyroid peroxidase
    - Mediated by TSH
  2. Organification: Thyroid peroxidase oxidizes iodine –> adds tyrosine molecule
  3. Coupling: thyroid peroxidase catalyzes coupling
    - Add 1 molecule = MIT
    - Add 2 molecules = DIT
  4. Hormone synthesis: mostly T4 released
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5
Q

What’s the most biologically active thyroid hormone?

A

T3

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6
Q

What’s the fastest form of thyroid?

A

T3

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7
Q

What enzyme catalyzes the deionidation of T4–> T3 in peripheral tissues?

A

Iodothyronine dioidinase

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8
Q

What would you expect to see in a euthyroid sick dog? (TT4, fT4, TSH)

A

TT4: low
fT4: normal/high
TSH: normal

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9
Q

What would you expect to see in a dog with a functional thyroid tumor (TSH, TT4, fT4)?

A

TT4: high
fT4: high
TSH: normal

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10
Q

What’s the most common cause of hyperthyroidism in cats?

A

Adenomatous hyperplasia - usually bilateral (70%)

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11
Q

What is the TSH in hyperthyroidism?

A

Low

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12
Q

What’s the gold standard for diagnosing hyperthyroidism? What result would be normal/what would you see with hyperthyroidism?

A

T3 suppression test
4 day test
1. Day 1 - measure T3 and T4
2. Day 2-3 - give oral T3
3. Day 4: 2-4h after the 7th dose: measure T3 and T4

Normal: high T3, low T4
Hyperthyroid: high T3 and T4

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13
Q

What’s the MOA of methimazole?

A

Inhibits thyroid peroxidase
-Prevent iodine incorporation into thyroid groups
-Prevent coupling of MIT + DIT –> T3+T4
-May interact with thyroglobulin molecule

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14
Q

What’s the 1/2 life of the thyroid?

A

8 days

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15
Q

What’s the most common cause of hypothyroidism in dogs?

A

Lymphocytic thyroiditis - immune mediated

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16
Q

What type of hypersensitivity rxn will we see from canine hypothyroidism?

A

Type II - like most immune mediated diseases

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17
Q

What breeds are predisposed to hypothyroidism?

A

Goldens – increase antibodies for thyroglobulin
Doberman
Fox, rat, tender field terrier
Irish setter
Boxer
Weiner dog
Cockers

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18
Q

What drug incudes hypothyroidism? HOW?

A

TMS - inhibits thyroid peroxidase activity + thyroid hormone synthesis
Would see low TT4 + FT4

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19
Q

What is a cause of 2ry hypothyroidism? Predisposed breed?

A

Cysts in rathe’s pouch - GSD

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20
Q

Gold standard for dx canine hypothyroidism

A

TSH stimulation
Hypothyroid: blunted response
Normal: high T4 to TSH

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21
Q

What would alkalosis do to iCa? Acidosis?

A

Acidosis = higher iCa
Alkalosis = lower iCa

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22
Q

If a sample if stored, how would that change pH?

A

Stored = pH increases = iCa lowers

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23
Q

PTH
Source
Site of action
Function

A

Source: chief cells of parathyroid gland
Site of action: renal tubule (DCT), duodenum, bone
Function: increase Ca, decrease phos

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24
Q

Vitamin D
Source
Site of action
Function

A

Source: Diet
Site of action: GIT, bone
Function: increase Ca, increase phos

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25
Q

Calcitonin
Source
Site of action
Function

A

Source: C-cells thyroid gland
Site of action: bone
Function: decrease Ca (inhibits osteoclasts)

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26
Q

What enzyme catalyzes the hhydroxilation of 25, OD-D (calcidiol) to 1,25-(OH)2-D (calcitriol)

A

Alpha 1 dehydroxylase

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27
Q

MOA of thiazide

A

Inhibit NaCL cotransporter in DCT

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28
Q

How is calcium filtered/absorbed in the kidney?

A

99% reabsorbed
-60%: PCT
-35-30%” ascending LOH
-4-9%: DCT

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29
Q

Major regulators of PTH

A

Ca (when plasma calcium is low –> PTH increases)
Hyperphosphatemia increases PTH secretion
Mg is required for normal PTH secretion

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30
Q

What the difference between osteoblast and osteoclas

A

Osteoclast- breakdown of bone
Osteoblast- growing, proliferating bone

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31
Q

Is vitamin D slow or fast acting? Why

A

SLOW - steroid hormone

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32
Q

What’s the active form of vitaminD

A

1, 25- dihydroxycholecalciferol (calcitriol)

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33
Q

Describe conversion of 25-hydroxycholecalciferol and where it happens

A

Cholecalciferol –> converted to 25-hydroxycholecalciferol by p540 enzyme in LIVER

Converted to 1,25-dehydroxycholecalciferol in the PCT of kidney

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34
Q

1/2 life of 25, hydroxycholecalciferol

A

weeks

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35
Q

1/2 life of 1, 25-dihydroxycholecalciferol

A

hours

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36
Q

What are the actions of calcitriol?

A

Intestine:
-Calcitriol forms a family. of calcium-binding proteins (calbindin-D) in the intestinal epithelial. cells –> calbindin D levels correlate with Ca transport . Also increases phosphorous absorption in the intestine

-Bone: works w/PTH to move Ca and phos from bone

-Kidney: promotes reabsorption of Ca + phos from kidney

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37
Q

What’s the major site of action of calcitriol?

A

Intestine

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38
Q

What’s the regulation mechanism of calcitriol?

A

Major site of regulation is formation of 1,25-dehydroxycholecalciferol in kidney by 1 alpha hydroxylate
- Increased with HYPOcalcemia + HYPOphosphatemia and PTH

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39
Q

What are the major differences between PTH and 1, 25-dehydroxycholecalceferol?

A

PTH
- Fast acting (polypeptide)
- Increases Ca and decreases Phos
-Cell surface receptors
-Minute to minute regulation
-Acts primarily on bone and kidney

Calcitriol
- Slow acting (steroid)
- Increases Ca and phos
-Nuclear. receptors
-Day to day regulation
-Acts primarily on GIT

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40
Q

What is calcitonin? Where is it synthesized?

A

Smal peptide
Parafollicular (C-cells) cells of thyroid gland

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41
Q

What the action of calcitonin?

A

Decrease Ca and Phos

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42
Q

Where does calcitonin act?

A

Bone: inhibits bone resorption via direct effect on osteoclasts
Kidney: increases calcium excretion

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43
Q

What is FGF23? Where does it act?

A

Fibroblast growth factor hormone (“phosphatonin”) – phosphate regulatory hormone
–Reduces serum phosphate levels by its suppressive effects on phosphate reabsorption: suppresses expression of Na-phos cotransortes in brush border of proximal tubule and reduces calcitriol (by suppressing 25-hydroxylase
Polypeptide

Acts on Klotho - cell surface protein necessary for activity

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44
Q

How does FGF23 suppress phosphate?

A

Suppresses effects of phosphate reabsorption – suppresses expression of type 2a and 2C Na-Phosphate cotransporter in brush border of PROXIMAL TUBULES and reduces calcitriol

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45
Q

What is effect of FGF23 on calcitriol?

A

Reduces calcitriol by suppressing 25-hydroxylase and enhancing expression of 24-hydrolyxase

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46
Q

What is the job of PTHrp

A

Regulation of Ca in fetus, mammaru gland, lower animals

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47
Q

What would PTHrp be in hypercalcemia of malignancy?

A

Typically high,, but can also be normal

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48
Q

Describe the pathogenesis of renal 2ry hyperparathyroidism

A

Disease of phosphorous retention** –> controlling hyperphosphatemia can prevent onset and progression of renal 2ry hyperparathyroidism

Phos excretion decreases with decreasing GFR

  1. Phos stimulates PTH production indirectly via suppressing vitamin D production, causing hypocalcemia
  2. Initially the increased PTH restores phosphorous levels to normal
  3. As GFR decreases more, the response becomes maladaptive –> further increase in PTH secretion can no longer normalize phosphorous excretion

Role of FGF23: decreases PTH secretion in early stages of CKD
Advanced stages: FGF23 –> decreased calcitriol –> indirectly promoting development of hyperparathyroidism bc of adequeate amounts of calcitriol are needed to INHIBIT PTH

Additionally: mechanism of increased PTH concentration is development of FGF23 resistance in parathyroid gland bc expression of Klotho cells is decreased

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49
Q

What’s the role of FGF23. in CKD?

A

Decrease PTH secretion in early CKD
Advanced stages: FGF23 –> decreased calcitriol –> indirectly promotes hyperparathyroidism (adequate amounts of calctriol needed to inhibit PTH)

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50
Q

Name DDX for hypercalcemia

A

H: hyperparathyroidism
-PTH (inappropriately) normal in 75%
-Concurrent low/low-normal pohsphorous
A: Addison’s
R: renal disease
-iCa usually normal or low
D: VitaminD tox
-Severe hyperphosphatemia
-Persist weeks-months
I: idiopathic (cats), inflammatory (especially granulomatous-fungal)
O: osteolysis
N: neoplasia (lymphoma, AGASACA, melanoma, thymoma, other round cells)
S: spurious

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51
Q

What % of dogs with primary hyperparathyroidism are azotemic

A

10%

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52
Q

Breeds predisposed to primary hyperparathyroidism

A

KEESHOND

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53
Q

Name DDX for hypocalcemia

A

Hypoparathyroidism (severely. hypocalcemic)
Malabsorption/hypovitaminosis D (PLE, EPI)
Renal disease
Pancreatitis
Puerperal tetany
Cheating agent (EG, citrated blood)
Phosphate enema tox
Eclampsia
Hypoalbuminemia

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54
Q

Fluid of choice for hyperlcalcemic patient

A

0.9% NaCl.

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55
Q

Name management of hypercalcemia

A

Fluids: 0.9%NaCl- natriuresis promotes calciuresis
Furosemide- natriuresis promotes calciuresis
Prednisone- promoted Ca loss in pee
Biphosphonates
-Alendronate: PO for cats
-Pamidronate: IV for acute tx
Calcitonin

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56
Q

MOA of alendronate/pamidronate
SE

A

Binds to bone hydroxyapatite –> inhibits osteoclast function –> reduces bone resorption

SE: GI signs

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57
Q

MOA and SE of calcitonin

A

MOA: osteoclast-inhibiting hormone – reduced tubular absorption of Ca, phos, Na, Mg, K, Cl –> promotes renal excretion
Also increases jejunal secretion of H2O, Na, k, Cl

SE: GI, hypocalcemia

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58
Q

Most common signs in 1ry hyperparathyroidism

A

LUTD (50%)

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59
Q

Breeds predisposed to primary hypoparathyroidism

A

Poodles toy <3
Terriers (westies, jack russels)
Labs
Mini schnauzer
GSD

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60
Q

Clinical presentation primary hypoparathyroidism

A

Seizures
Facial rubbing
Hyperventination
Tetany, stiff gait, muscle fasciculations
Posterior lenticular cataract

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61
Q

Where are the catecholamines secreted from?

A

Medulla of adrenal gland

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62
Q

What catecholamine do cats normally secrete?

A

Norepi
While dogs – epinephrine

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63
Q

What’s the common precursor of catecholamines?

A

Tyrosine

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64
Q

How is norepinephrine synthesized?

A

Hydroxylation and decarboxylation of TYROSINE

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65
Q

How is epinephrine synthesized?

A

Methylation of NE

66
Q

Which enzyme methylates epinephrine to NE?

A

PNMT - phenylethanolamine N-methyltransferase
- Induced by glucocorticoids

67
Q

What’s the 1/2 life of the catecholamines?

A

2 min

68
Q

Enzyme that oxidizes/breakdown NE and Epi?

A

Monomine oxidase (MAO)
Also part of the methylation of metinephrine

69
Q

Most specific test for screening for a pheo

A

Urine metanephrine

70
Q

MOA and SE Phenoxybenzamine

A

MOA: non-competitive, non-selective alpha-adrenoreceptor blocker
Adverse effects: hypotension, weakness, dizziness, vomiting, miosis

71
Q

Alpha receptors cause x of blood vessels

A

Constriction

72
Q

Beta receptors cause x activity of smooth muscle and x of blood vessels

A

Decreased activity
Vasodilation
Exception: heart – contraction

73
Q

Name the different receptors in the body organs

A
74
Q

Describe the anatomy of the adrenal glang

A

Adrenal cortex:
1. Zona glomerulosa: Mineralcorticoids (aldosterone) - 7% of adrenal mass
2. Zona fasciculata: glucocorticoids (steroids) -50% of adrenal mass
3. Zona reticularis: sex hormones - 7% adrenal mass

Adrenal medulla: catecholamines (epi and NE) - 28% adrenal mass

75
Q

Adrenocortical hormones are synthesized from what?

A

Derivatives of cholesterol- like vitamin D, bile acids
Synthesized by various members of cytochrome p450 fam

76
Q

MOA of trilostane

A

3-B-hydroxysteroid dehydrogenase
-NOT a cytochrome p450
-Converts prednenolone to progesterone
-Most active in zona fasciculata (steroids here)

77
Q

What enzyme catalyzes the formation of free cholesterol to lipid droplets?

A

Cholesterol ester hydroxylate

78
Q

What’s the most imp rate limiting step in the steroid pathway?

A

Pregnenolone!

79
Q

What enzyme converts cholesterol to prednenolone?

A

Cholesteroldesmolase

80
Q

What enzyme does etomidate and metyrapone inhibit?

A

11-B-hydroxylase
-Not present in zona glomerulosa

81
Q

What 2 enzymes does the zona glomerulosa lack?

A

11-b-hydroxylase + 17-a-hydroxylase

82
Q

What does type I 11B hydroxysteroid dehydrogenase do?

A

Reduces cortisone (inert) to active cortisol –> activate glucocorticoid receptor
Also metabolizes prednisone (inactive) to prednisolone (active)

83
Q

What does type 2 11B hydroxysteroid dehydrogenase do?

A

In aldosterone selective tissues – oxidizes cortisol to cortisone (inactive) to prevent activation of mineralocorticoid receptor by cortisol
Inhibited by licorice –> activation of mineralocorticoid receptorW

84
Q

MOA ketoconazole

A

Cytochrome p450 inhibitor

85
Q

What are the actions of ACTH?

A
  1. Bind to membrane receptor
  2. Activate adenylul cyclase via Proteins
  3. Increase conversion of chol–>pregnenolone
    4.Increases production of cytochrome p450 enzymes
86
Q

What are the actions of AgII in the adrenal gland?

A

At1 receptor
Increases conversion of cholesterol–>prednenolone
Facilitates aldosterone synthesis

87
Q

Bound steroids are physiologically (inactive/active)

A

INACTIVE

88
Q

Plasma 1/2 life of cortisol

A

60-90min

89
Q

Aldosterone 1/2 life

A

20min

90
Q

What enzyme converts cortisol to cortisone?

A

11-HSD

91
Q

What do these cells in the Islet of Langerhans secrete?

A

alpha: glucagon
beta: insulin
delta: somatostatin
F-cells: pancreatic polypeptide

92
Q

What comprises an insulin molecule?

A

alpha chain, beta chain, C-peptide. joined by disulfide bond

93
Q

What’s the clinical use of C peptide?

A

Can measure endogenous pancreatic function and insulin secretion

94
Q

What 2 insulin species are identical?

A

Porcine and canine

95
Q

How do bovine and feline insulin defer?

A

Differ by one AA only

96
Q

Name the long acting insulin

A

glargine and detemir

97
Q

AA added to each of these
-Glargine
-Detemir
-Lispro
-Aspart

A

-Glargine: Glycine
-Detemir: Lysine–>Fatty acid binds to albumin, then slowly dissociates from albumin
-Lispro: Lys + Pro
-Aspart: Asp

98
Q

Which insulins use U-40

A

Vetsulin and Prozinc

99
Q

Insulins classified according to what

A

Species of origin, formulation, strength

100
Q

How much of the glucose absorbed from the gut is stored in the liver as glycogen?

A

2/3

101
Q

The insulin receptor is a xxx receptor

A

Enzyme-linked

102
Q

What enzyme splits glycogen to glucose? Where does this occur

A

Liver phosphorylase

103
Q

Insulin enhances uptake of glucose from the blood by liver by increasing what enzyme?

A

Glucokinase

104
Q

What happens when the insulin coming into the liver is more that what can be stored as glycogen?

A

Insulin promotes conversion into FA –> packaged as triglycerides in VLDL –> transported in blood to adipose tissue –> FAT

105
Q

Factors that lead to increase fatty acids in the liver

A
  1. Increase glucose transport into liver cells by insulin (glucose–>pyruvate–>acetyl co-A (substrate to which FA are formed)
  2. Excess citrate and isocitrate ions from when excess amount of glu is used for energy –> activate acetyl-con carboxylase–> carboxylate acetyl coA–> mallonyl Coa (1t stage of FA synthesis)
  3. Most FA synthesized in liver and used to form trigs
106
Q

What are the effects of insulin on fat storage

A

inhibits action of hormone-sensitive lipase
promote glucose transport through cell membrane –>fat cells

107
Q

In the absence of insulin, which enzyme becomes strongly activated and leads to FA and glycerol being released into the blood?

A

hormone sensitive lipase
FFA become substrate for energy :(

108
Q

Whars the sequelae to excess of fat during insulin deficiency

A

Ketosis and acidosis (insulin deficiency causes acetoacetic acid to be formed in liver cells)
Also have a decreased amount of usage. of acetoacetic acid in peripheral tissues

109
Q

What makes up acetoacetic acid

A

Acetone (ketone bodie)s and beta hydroxybutiric acid

110
Q

What enzyme phosphorylates glucose to glucose 6-phosphate?

A

Glucokinase

111
Q

What’s the rate limiting step for glucose metabolism in beta cells?

A

Phosphorylation of glucose

112
Q

Describe the pathway of insulin secretion

A
  1. Glucose is phosphorylated inside the cell by glucokinase enzyme to 6-glucose-phosphate
  2. Glu-6-phosphate is oxydyzed to ATP
  3. ATP inhibits the ATP sensitive K+ channels
  4. CLOSURE of K+ channels –> depolarization of cell membrane
  5. Opening of Ca-voltage gated channels
  6. Influx. of Ca –> stimulates fusion of docked insulin-containing vesicles
  7. Secretion of insulin via exocytosis
113
Q

What transporter mediated glucose entering the cell?

A

GLUT2

114
Q

How does the drug diazoxide work to increase insulin? SE?

A

Used in insulinomas
Works on the K-channel to keep them open
MOA: vasodilator of smooth muscle, stimulate beta-adrenergic system
Decreases bodys ability to decrease intracellular release of ionized Ca –> prevents release from beta cell insulin granules

SE: DM, pancreatitis, GI signs, hypersalivation

115
Q

MOA and SE of glipizide

A

MOA: sulfonyurea antidiabetic agent (insulin secretagogue)
-Keeps K channels closed to increase insulin secretion

116
Q

What causes increase insulin secretion?

A
  1. High BG
  2. High FFA
  3. High AA
  4. Intestinal hormones (Secretin, Insulin dependent peptide, glucagon like peptide 1, gastrin, CCK)
  5. PS activation
  6. Beta adrenergic stimulation
  7. Xylitol dogs
117
Q

What decreases insulin secretion?

A
  1. Low BG, fasting
  2. Somatostatin
  3. Alpha adrenergic
  4. Leptin
118
Q

What are incretins?

A

Enzymes that enhance rate of insulin release from pancreatic bet cells in response to increase high plasma glucose

GLP-1 and GIP

119
Q

What can glucagon do? Where is it secreted. from?

A

Alpha cells from islet of langerhans
Hyperglycemic drug -increases BG

High doses it can
-Increase heart strength
-increase blood flow to some tissues
-increase bile secretion
-inhibit gastric acid secretion

120
Q

What are the inhibitory effects of somatostatin

A

-decrease secretion of insulin and gluconagon
-decrease motility of stomach, duodenum, GB
-decrease secretion and absorption in GIT

121
Q

First choice of insulin for dog and cat

A

Dog: intermediate acting - vetsulin
Cat: long acting- glargine

122
Q

Diabetogenic hormones

A

Glucagon
Glucocorticoids
Growth hormone
Catecholamines

123
Q

What is hormone sensitive lipase? Where is it located? Function? Activation? Inhibition?

A

Hormone that promotes use of FFA for energy
Stored in adipocytes
Function: hydrolysis of reserve triglycerides
Activation: cathecholamines, glucagpn
Inhibition: insulin, prostaglandins

124
Q

What are the counter regulatory insulin hormones?

A

Glucagon
Glucorticoids
Cathecholamines
GH

125
Q

What are the catabolic effects of glucagon?

A

Increase gluconeogenes
Increase glycogenolysis
Increase lipolysis
Increase ketone body formation

126
Q

PTH promotes osteoclasts or osteoblasts?

A
  • PTH decreases osteoblast activity and increases osteoclast
127
Q

What cells produce fibroblast growth factor 23 (FGF 23)?

A

Osteocytes

128
Q

Where is cholecalciferol to 25 hydroxycholecalciferol made?

A

in liver

129
Q

Where is 1,25 dihydroxycholecalciferol made?

A

Kidney

130
Q

What’s the effect of angiotensin II on aldosterone?

A

ANGIOTENSIN II increases aldosterone production

131
Q

What enzyme oxidizes cortisol to cortisone in aldosterone responsive tissues?

A

11B-hydroxysteroid dehydrogenase type 2

132
Q

What is the distribution of the GLUT 1-4 transporters and what’s the function of each?

A
133
Q

MOA of bexagliflozin? SE?

A

MOA: Na-glucose cotransporter 2 (SGLT2) inhibitor
-This transported is found in renal PCT–> absorbs renal glucose and lowers renal threshold for glucose–>increase urinary glucose excretion
-Also inhibit renal Na absorption–> delivers increased Na load to distal tubules (in humans this inhibits RAAS, increases GFR)

SE: diarrhea, glucosuria, polyuria, ketonuria, polyphagia, elevated BUN, USG, serum fPL, UTIs, ELEs, wt loss

134
Q

What is the function of SGLT1?

A

Glucose absorption from distal intestinal lumen

135
Q

What’s the insulin regulated glucose transporter?

A

GLUT4

136
Q

What’s the function of SGLT2?

A

> 90% of glucose reabsorption from glomerular ultrafiltrate

137
Q

What GI hormones decrease hunger?

A

Letin, Adiponectin

138
Q

What hormone stimulates appetite? Where is it produced? where does it act on?

A

Ghrelin
Produced in stomach cells
Acts on hypothalamus

139
Q

What’s the action of glucagon-like peptide? Where is it produced?

A

Produce in GIT by enteroendocrine L-cells and brainstem
Stimulates insulin secretion

140
Q

Describe the mechanism for insulin resistance in obesity

A

Downregulatiion of GLUT4
Impaired binding to insulin receptor
Decreased leptin secretion
Decreased # of insulin receptors

141
Q

What to treat first for DKA

A

0.9% NaCl

142
Q

Most common cause of insulin resistance in cats

A

—high somatotrophin

143
Q

What’s the effect of insulin on LPL (lipoprotein lipase) and fat?

A

Stimulates FFA storage in adipocytes and liver
Inhibits hormone sensitive lipase, to keep triglycerides within the adipocyte.

144
Q

How does insulin inhibit lipolysis?

A

Inhibiting hormone sensitive lipase (this enzyme breaks down FA)

145
Q

Insuline is requires for glu entrance and use in most adipose and muscle cells via which transporter

A

GLUT4

146
Q

What pro inflammatory cytokines can lead to insulin resistance?

A

TNFalpha IL6

147
Q

Describe the metabolic effects of insulin deficiency

A

Metabolic shift from glycolysis to lipolysis, protein catabolic, glycogenolysis

148
Q

Where are ketone bodies synthesized?

A

Liver from beta oxidation of FFAs

149
Q

What enzyme reduces acetoacetate to Beta hydroxybutyrate?

A

NADH

150
Q

What are the major ketone bodies? Which contribute to the acidosis?

A

Acetoacetate, beta-hydroxybutyrate - strong acids
Acetone - not acidic

151
Q

What’s the major ketone found in diabetics

A

Beta hydroxybutyrate

152
Q

What ketone bodies does the urine dipstick read?

A

Acetoacetate and acetone

153
Q

What ketone body is measured with serum ketone meters?

A

beta hydroxybutyrate

154
Q

What’s the most ketogenic of the counter regulatory hormones

A

Glucagon

155
Q

Who activates hormone sensitive lipase in DKA

A

glucagon

156
Q

What are the glucose counterregulatory hormones

A

glucagon, epinephrine, cortisol growth hormone

157
Q

What would the total body K be in DKA, and why?

A

Can initially read low, high, normal

Total body deplition generally present bc of GI and renal losses and decrease intake
-Acidemia, relative insulin deficiency, hypertonicity–> pulls K from the ICF–>ECF = falsely elevated measure of serum K

Tx will result in K to move back into cells and serum K will decrease

158
Q

What would the total body Na be in DKA, and why?

A

Total body depletion of Na due to renal losses (regardless of initial serum level)

As ICF is pulled into vascular space due to osmotic pull of hyperglycemia. –> plasma Na concentration will decrease

159
Q

What would you expect the phosphorous to be in a DKA patient

A

Initial bloodwork - elevated because of dehydration and renal insufficiency

As it shifts into IC compartment with glucose when insulin is available –> severe decrease in levels

Phos: major intracellular anion, source of ATP production intracellularly, cell membrane maintenance

160
Q

What can severe hypophosphatemia (<1mg/dL) cause?

A

Hemolytic anemia, lethargy, depression, D+

161
Q

What do we need to look into if you have a DKA patient with refractory hypokalemia. despite appropriate potassium replacement therapy?

A

Magnesium deficiency

162
Q

What would indicate “suppression” in a LDDST for HAC?

A

->50% less than baseline cortisol
-<1.4 ug/dL

ACVIM General - Imp stuff (11 decks)

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