endocrine Flashcards
Which type of DM is insulin dependent and typically develops in a younger patient?
type 1
Which type of DM is associated with unintentional weight loss?
type one DM
Which type of DM is associated with ketone development? (ketonemia, Ketonuria)
type one DM
Name three differentials for unintended weight loss
cancer
DM type 1
TB
hyperthyroidism
HIV/AIDS
Depression
What are the normal values for BUN?
10-20
What are the normal values for creatinine?
0.5-1.5
Name three causes of elevated BUN
dehydration
GI bleeding
high protein diet
What is the most sensitive indicator of renal function?
Serum creatinine
normal hgb A1c
5.5-7
normal fasting BG
60-99
How much of a diet should be carbohydrates?
55-60%
When do you start somebody on insulin?
If they present with ketoneuria or ketonemia
How do you begin insulin therapy?
0.5units/kg/day
giving 2/3 of the dose in the morning and 1/3 in the evening
What are two causes of early morning hyperglycemia?
Dawns phenomenon
Somogyi phenomenon
If a patient is hypoglycemic at 03:00 and then their BG rebounds and surges to hyperglycemia is their problem somogyi or dawns phenomenon?
Somogyi, because it is opposite, the treatment is to reduce or omit the PM dose of insulin
If a patient is hypoglycemic at 03:00 and then their BG is high and it continues to rise. Is their problem somogyi or dawns phenomenon?
Dawns, it rises, treatment is to increase the insulin
What are diagnostic criteria for metabolic syndrome?
BP > or = 130/85
obesity
fasting BG > or = to 100
waist circumference (visceral adiposity)
elevated triglyceride level >150
HDL<40 in men
HDL< 50 in women
*you need three of these criteria for diagnosis
What is the step-wise approach to the treatment of DM II?
weight reduction
dietary changes
oral antidiabetics
insulin therapy
Which type of DM has an insidious onset, pt may present with repeated vagitnitis, chronic cellulitis, recurrent prescription glassess changes?
type 2 DM
What are some examples of sulfonyureas and what is their mechanism of action?
glipizide, glyburide
stimulate the pancreas to release more insulin
What is an example of a biguinide and what is its mechanism of action and what is a side effect?
metformin
side effect: lactic acidosis
What is the standard of care per ADA for the treatment of type II DM?
metformin
What would you consider in a presention of intracellular dehydration with elevated BG>250, hyperkalemia, ketonemia, ketonuria?
type one diabetes, DKA
What would you consider in a presentation of dehydration, BG>1200?
HHNK
What is normal serum osmolality?
275-285
When the patient is acidotic is the potassium high or low?
high, low pH = high K+
How do you resuscitated DKA patient?
1st isotonic (NS or LR) until stable
2nd hypotonic (to treat intracellular dehydration)
1/2NS
3rd once BG trends down D5 1/2
How do you start an insluin gtt?
0.1units/kg of regular followed by 0.1units/kg/hr
Which has a normal anion gap, DKA or HHNK?
HHNK
What is the most common presentation of hyperthyroidism?
Graves disease
What is the most common cause of HYPOthyroidism?
Hashimoto’s thyroiditis
What are causes of hyperthyroidism?
TSH secreting tumor
pituitary tumor
high dose amiodarone
Graves disease
Symptoms of hyperthyroidism
bulging eyes
heat intolerance
increased appetite with associated weight loss
Labs associated with hyperthyroidism
TSH is low
T3 elevated
T4 can be elevated
Medications used for hyperthyroidism
propranolol for symptoms (for shakes and palpitations)
PTU for treatment of hyperthyroidism
Iodine deficiency can be caused by:
iodine deficiency
What are the labs associated with hypothyroidism?
TSH elevated
T4 low
T3 is not definately associated with hypothyroidism diagnosis
Extreme hypothyroidism can lead to:
Myxedema coma
ACTH hypersecretion
Cushings
Cushings is caused by:
hypersecretion of ACTH
adrenal tumors
chronic administration of glucocorticoids (like in transplant patients)
Moon face, buffalo hump, risk for infections, acne, hirtuism
chronic steroid users
and/or
cushings
because of increase in androgens
Who will have HTN, the patient with cushings or the patient with addisons?
Cushings because ACTH–> steroids–> vasoconstriction
What are the triad of labs for cushings?
hyperglycemia (because steroids prevent the uptake of glucose in the cell)
hypernatremia
hypokalemia
What are the triad of labs for addisons disease?
hypoglycemia
hyponatremia
hyperkalemia
What is the product of aldosterone and androgen?
mineralocorticoids
What is the treatment of addisons?
glucocorticoids and mineralocorticoids
Innapropriate water retention, hyponatremia, caused by skull fracture brain tumor and lung disease.
SIADH (too much ADH)
In SIADH the urine osmolality is high or low?
high
If patient is hyponatremic and Na is greater than 120 what is the treatment?
limit fluid to one liter a day
If sodium is 110-120 and patient is symptomatic how do you treat?
3% or hypertonic IV fluids
What are the three types of DI?
central (hypothalmic or pituitary)
nephrogenic (acquired from pylo)
psychogenic
Signs and symptoms of DI
polyuria
excessive thirst
signs of dehydration
dilute urine
Is the serum osmo high or low in DI?
high
How do you discern central from nephrogenic DI?
Vasopressin challenge:
+ in central
- in nephrogenic
How do you treat hypernatremia?
D5W
How do you teach a patient to use outpatient DDAVP?
intranasally
Pheocromocytoma
adrenal medulla tumor
characterized by paroxysmal or sustained HTN due to excssive circulating catecholamines
labile BP applies to pt’s with hyperthyroidism OR pheochromocytoma
pheochromocytoma
Tests of pheochromocytoma
plasma free metanephrines
urine metanephrines (24 hour), urine cr, catecholamine, VMA
To confirm pheochromocytoma CT scan
management of pheochromocytoma involves
surgical incision of the tumor, watch for adrenal insufficiency and hemorrhage post-op
