endocrine

Question 1

hypoglycemia: tx

Answer 1

check: sulfonylureas, renal fx (poor clearance?), missed meals
D50 (watch for rebound) or 100 mL D10 > PO
- if no IV access, 5 mg glucagon IM
- if pt can’t take PO: D5W @75-100

Question 2

sulfonylurea hypoglycemia: tx

Answer 2

dextrose + octreotide 50-150 mcg q6h > admit for monitoring

Question 3

hypoglycemia: DDx for the ill pt

Answer 3

sepsis
liver, kidney, or heart failure
malnutrition
cortisol deficiency

Question 4

hypoglycemia: DDx for the well pt

Answer 4

accidental/intentional insulin OD
EtOH abuse (thiamine!)
s/p gastric bypass
reactive (to food intake w/n 4h)
alimentary (soft stools after eating w/hypoglycemic sx)

Question 5

octreotide mechanism of action

Answer 5

closes voltage-gated Ca channels that allow for insulin release

Question 6

thyroid storm tx

Answer 6

1. propranolol: sympatholysis
   2a. PTU (if pregnant): blocks hormone synthesis and conversion of T4 to T3
   2b. methimazole: blocks hormone synthesis
2. iodine (1h after step 2): inhibits stored hormone release
3. steroids: blocks conversion of T4 to T3

Question 7

HHS

Answer 7

hyperglycemia, AMS, hyperosm in a T2DM WITHOUT ketoacidosis 2/2 severe dehydration from osmotic diuresis or infection

tx: IVF

Question 8

pseudohyponatremia

Answer 8

for every 100 increase in glucose, add 1.6 to Na