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2 Endocrine > Endocrine Biochemistry > Flashcards

Endocrine Biochemistry Flashcards

1
Q

how are carbohydrates metabolised?

A

glycolysis?

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2
Q

where do all the reactions of glycolysis take place?

A

cytoplasm of cell

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3
Q

how does insulin increase glucose breakdown?

A

increases hexokinase activity

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4
Q

does glucagon increase or decrease activity of phosphofructokinase?

A

decrease

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5
Q

how are ketone bodies produced in DKA?

A

low adipose stores from the increased lipolysis = increased free fatty acids
oxidation of free fatty acids by the liver by acetyl coA = ketones

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6
Q

what drives oxidation of free fatty acids?

A

acetyl coA

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7
Q

what hormone is important in accelarating fatty acid oxidation?

A

glucagon

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8
Q

what does adrenaline do?

A

glucagon release and lipolysis

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9
Q

does adrenaline increase fatty acids, ketones or both?

A

fatty acids only

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10
Q

what does cortisol do?

A

stimulates gluconeogenesis in the liver

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11
Q

what does growth hormone do?

A

promotes glycolysis

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12
Q

cause of DKA?

A

absolute or relative insulin deficiency plus

increase in counter regulatory hormones

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13
Q

what kind of ABG would be seen in someone with DKA?

A

anion gap metabolic acidosis

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14
Q

what causes insulin deficiency in type 1?

A

atrophy of islets of langerhans

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15
Q

what happens to cells when you dont take your insulin?

A

reduced cellular uptake of glucose in muscle and fatty tissue

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16
Q

immediate effects of low insulin on the body?

A

hyperglycaemia
increased hepatic gluconeogenesis
increased level of catecholamines

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17
Q

what happens to lipolysis in low insulin?

A

reduces suppression of lipases so you get increased lipolysis

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18
Q

how does adrenaline react to insulin deficiency?

A

stimulates glucagon release and lipolysis

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19
Q

does adrenaline increase production of fatty acids, ketones or both in insulin deficiency?

A

just fatty acids

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20
Q

how does cortisol react to insulin deficiency?

A

stimulates gluconeogenesis from amino acids

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21
Q

how does growth hormone react to insulin deficiency?

A

promotes lipolysis

reduces hepatic uptake of glucose

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22
Q

what would the pH and HCO3 values be for someone in DKA?

A

ph <7.3

hcog < 15mmol

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23
Q

what tests are done to exclude other causes of acidosis?

A

urinalysis
ABGs
plasma ketones
U+Es

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24
Q

what is the main reason for doing urinalysis?

A

determine the presence of urinary ketones

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25
Q

what is the main reason for doing ABGs?

A

to see what the pH and HCO3 levels are

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26
Q

what is the main reason for doing blood ketones?

A

measures level of ketosis

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27
Q

what is the main reason for doing U+Es?

A

indication of dehydration and hyperkalaemia

tells you individual ion and anion levels

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28
Q

what are the parts of the urinalysis strip that you shouldn’t look at in DKA?

A

urobilinogen

bilirubin

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29
Q

why should you look at protein on a urinalysis strip of someone with suspected DKA?

A

could suggest diabetic nephropathy, UTI or both

30
Q

why should you look at blood on a urinalysis strip of someone with suspected DKA?

A

could suggest diabetic nephropathy, UTI or both

31
Q

why should you look at leukocytes on a urinalysis strip of someone with suspected DKA?

A

suggests urosepsis

32
Q

why should you look at nitrites on a urinalysis strip of someone with suspected DKA?

A

suggests urosepsis

33
Q

why should you look at specific gravity on a urinalysis strip of someone with suspected DKA?

A

suggests dehydration

34
Q

what conditions can cause sepsis in a diabetic?

A 
UTI
chest infection
gastroenteritis
cellulitis
cholecystitis
35
Q

what drugs can cause DKA?

A

corticosteroids
diuretics
surgery

36
Q

normal anion gap range?

37
Q

how do you calculate the anion gap?

A

(Na conc + K conc) - (Cl conc + HCO3 conc)

38
Q

name the 3 types of ketone body

A

acetone
beta-hydroxybutyrate
acetoacetate

39
Q

name 2 intermediate breakdown products that will accumulate in hepatocytes when insulin is deficient

A

acetyl coA

NAD+

40
Q

what happens to excess acetyk coA in DKA?

A

used for ketongenesis

41
Q

what happens to HCO3 in DKA?

42
Q

how does the body compensate in severe acidosis?

A

hyperventilation (kussmaul breathing)

43
Q

what will the patient’s oxygen and co2 levels look like if they have kussmaul breathing?

A

low co2

normal oxygen sats

44
Q

how would low electrolytes present clinically?

A

dehydration

45
Q

why would you get hyponatraemia in DKA?

A

from vomiting

46
Q

why would you get hypokalaemia in DKA?

A

happens in acidosis

47
Q

how can hyperglycaemia cause hyponatraemia?

A

increased urinary output due to osmotic diuresis in hyperglycaemia

48
Q

what effect does normal insulin production have on the distribution of potassium in the body?

A

acts on the sodium/potassium pump to drive potassium into the cells in exchange for sodium

49
Q

what effect does an insulin deficiency have on the distrubution of calcium in the body?

A

potassium excreted in urine so intracellular K is low and extracellular is high
total body K low

50
Q

what causes nephrogenic diabetes insipidus?

A

hypokalaemia

hypercalcaemia

51
Q

what happens to the kidneys in nephrogenic DI?

A

they become resistant to ADH

52
Q

name the 2 kinds of diabetes insipidus?

A

cranial

nephrogenic

53
Q

cause of cranial DI?

A

disturbance in posterior pituitary preventing ADH release

54
Q

normal urine osmolality?

55
Q

how do you calculate serum osmolality?

A

2(Na+K) + glucose + urea

56
Q 
calculate the serum osmolality:
Na = 149
K = 4
Urea = 9
Glucose = 5
57
Q

what drug can cause DI?

58
Q

why can you get a headache in diabetes insipidus?

A

subarachnoid haemorrhage

pituitary apaplexy

59
Q

cause of pituitary apaplexy?

A

sudden bleed or infarct

60
Q

what test should be done to confirm DI?

A

water deprivation test

61
Q

how is the water deprivation test done?

A

patient doesn’t have a drink for a few hours to see if their urine concentrates

62
Q

what urine osmolality indicates normal concentrating ability?

63
Q

how could you differentiate cranial and nephrogenic DI?

A

give synthetic ADH; if cranial you will go back to normal because your kidneys are fine BUT in nephro your kidneys are messed up so they still wont respond

64
Q

what is panhypopituitarism?

A

all hormones low

65
Q

2 essential tests for pituitary pathology?

A

visual field

MRI

66
Q

what test is done for addisons?

A

synacthen test

67
Q

reference cortisol range in early morning?

A

280-720nmol/l

68
Q

what should give someone if theyre androgen deficient?

69
Q

how would you treat a patient with and why:
high Na
low K
low urea

A

spirinolactone
surgery

as too much mineralocorticoid

70
Q

how would you treat a patient with:
low Na
high K
high urea

A

hydrocortisone as it is adrenal insufficiency

71
Q

what condition do these results indicate:
Na low
K low
urea low

A

SIADH as they have high urine sodium but low serum osmolality

72
Q

how can you get hypovolaemic shock in T1DM?

A

fluid loss through pee

2 Endocrine (35 decks)

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