Endocrine Flashcards
Cause of Type 1a, 1b DM
Type 1 DM, autoimmune beta cell destruction results in minimal or no insulin production
1b, not autoimmune; no INSULIN
DM type 2 cause
Not immune mediated, Defects in insulin receptors and postreceptor signaling
what is the most common chronic childhood dz
DM 1
What 3 important features of DM 2
Minimal insulin production, liver releases more glucose and cells avoid using glucos, glucose stays in the blood stream
Contributing factors to DM 2
Genetic (insulin resistance), obesity, sedentary lifestyle
What factor is inherited in the cause of DM 2
insulin resistance
What is metabolic syndrome
Characteristics that lead to DM 2
Insulin resistance, HTN, dyslipidemia, procoagulant state trombus), obesity
Dx for DM 2 levels include fasting level, random plasma glucose level, and 2 hr plasma level of
fasting- more than 130, 200
Side effect of bioguanides and what is less common in these type of oral antiglucemics
lactic acidosis
Less common risk of hypoglucemia
Meds increase risk of hypoglucemia
Oral antiglucemics, ACE inhibitors, Beta blockers, MOA, alcohol alcohol competes with liver for metabolism)
DKA is seen in which type of DM
1
DKA tx
Fluids, insulin, electrolyte imbalance
Electrolyte imbalaces of DKA
Hypokalemia, hyponatremia and low bicarbonate
Hyperglycemic hyperosmolar syndrome is seen in
TYPE 2 DM, older pts
Tx of hyperglycemic hyperosmolar syndrome
fluids, insulin, correction of electrolytes same as DKA
WHen should oral hypoglucemics be stopped ***
24-48 hrs before surgery
DM management, maintain blood glucose in which levels
100-180
What is insulinoma, are the malignant or benign, where are they located and what do they secrete
Rare, benign, insulin releasing tumor located in pancreatic islet cells
What is MEN
MEN syndrome: insulinoma, hyperparathyroidism, and pituitary tumor
Tx for Insulinoma
diazodide, inhibits insulin release
Other veramapil, phenytoin, propanolol, glucocorticosteroids, somastatin, octreotide, and lancreotide
Whipples triad
Hypoglucemia fasting, blood glucose at 50, resolves iwth glucose
Meds used in hyperthyroidism management
May use: opioids, VA, N2O, thipental (decreases conversion of T4 to T3)
Avoid: indirect acting vasopressors, drugs that stimulate sympathetic NS.
NMB: small Nondep, due to coexisting MG
What complications can be caused with removal of thyroid gland
Hypothyrodism, hemorrhage with tracheal compression, unilateral or bilateral RLN damage, motor nerve of SLN damage and removal of hypothyrodism
Thyroid storm may be precipitated by
Trauma, infection, SURGERY and stress
Thyroid storm pahtophysiology
Inhibition of thyroid hormone binding to proteina and more free thyroid hormone
Meds used in anesthesia management of hypothyroidism
Avoid: opioids
Use: direct acting vasopressors, pancuronium
Management for thyroid storm
glucose solution, antithyroid meds, Bblockers, decadrone, for afib-bblockers and digilatis, cooling
What period will thyroid storm be seen?
Postop after emergency surgery if inadequaltely treated
In subclinical hypothyrodism, what levels of TSH is associted with a CAD risk
More than 10 mu/l
What levels of TSH are associated with euthyroid and hypothryroid
euthyroid: 10, hypothyroid 5
Is Regional anesthesia safe for hyperthyrodism
YES, it is preffered
Pt with angina and hypothyrodism should get a______ before hormone replacement
Angiography
Medication used for hypothyrodism
For emergency before surgery
I-Thyroxine
Triiodothironine
For Goiter Thyroid tumors what type of anesthesia
VA, N2O and NO NMB
Preop corticosteroids are given to patients
who have been receiving more than 20 mg daily of prednisone or glucocorticosteroids are considered with Adrenal inhibition
What is the most common cause of AI
Administration of exogenous steroids
