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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
what is the main reason for doing ABGs?
to see what the pH and HCO3 levels are
26
what is the main reason for doing blood ketones?
measures level of ketosis
27
what is the main reason for doing U+Es?
indication of dehydration and hyperkalaemia | tells you individual ion and anion levels
28
what are the parts of the urinalysis strip that you shouldn't look at in DKA?
urobilinogen | bilirubin
29
why should you look at protein on a urinalysis strip of someone with suspected DKA?
could suggest diabetic nephropathy, UTI or both
30
why should you look at blood on a urinalysis strip of someone with suspected DKA?
could suggest diabetic nephropathy, UTI or both
31
why should you look at leukocytes on a urinalysis strip of someone with suspected DKA?
suggests urosepsis
32
why should you look at nitrites on a urinalysis strip of someone with suspected DKA?
suggests urosepsis
33
why should you look at specific gravity on a urinalysis strip of someone with suspected DKA?
suggests dehydration
34
what conditions can cause sepsis in a diabetic?
``` UTI chest infection gastroenteritis cellulitis cholecystitis ```
35
what drugs can cause DKA?
corticosteroids diuretics surgery
36
normal anion gap range?
8-16
37
how do you calculate the anion gap?
(Na conc + K conc) - (Cl conc + HCO3 conc)
38
name the 3 types of ketone body
acetone beta-hydroxybutyrate acetoacetate
39
name 2 intermediate breakdown products that will accumulate in hepatocytes when insulin is deficient
acetyl coA | NAD+
40
what happens to excess acetyk coA in DKA?
used for ketongenesis
41
what happens to HCO3 in DKA?
decreases
42
how does the body compensate in severe acidosis?
hyperventilation (kussmaul breathing)
43
what will the patient's oxygen and co2 levels look like if they have kussmaul breathing?
low co2 | normal oxygen sats
44
how would low electrolytes present clinically?
dehydration
45
why would you get hyponatraemia in DKA?
from vomiting
46
why would you get hypokalaemia in DKA?
happens in acidosis
47
how can hyperglycaemia cause hyponatraemia?
increased urinary output due to osmotic diuresis in hyperglycaemia
48
what effect does normal insulin production have on the distribution of potassium in the body?
acts on the sodium/potassium pump to drive potassium into the cells in exchange for sodium
49
what effect does an insulin deficiency have on the distrubution of calcium in the body?
potassium excreted in urine so intracellular K is low and extracellular is high total body K low
50
what causes nephrogenic diabetes insipidus?
hypokalaemia | hypercalcaemia
51
what happens to the kidneys in nephrogenic DI?
they become resistant to ADH
52
name the 2 kinds of diabetes insipidus?
cranial | nephrogenic
53
cause of cranial DI?
disturbance in posterior pituitary preventing ADH release
54
normal urine osmolality?
100-900
55
how do you calculate serum osmolality?
2(Na+K) + glucose + urea
56
``` calculate the serum osmolality: Na = 149 K = 4 Urea = 9 Glucose = 5 ```
320
57
what drug can cause DI?
lithium
58
why can you get a headache in diabetes insipidus?
subarachnoid haemorrhage | pituitary apaplexy
59
cause of pituitary apaplexy?
sudden bleed or infarct
60
what test should be done to confirm DI?
water deprivation test
61
how is the water deprivation test done?
patient doesn't have a drink for a few hours to see if their urine concentrates
62
what urine osmolality indicates normal concentrating ability?
>750
63
how could you differentiate cranial and nephrogenic DI?
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
what is panhypopituitarism?
all hormones low
65
2 essential tests for pituitary pathology?
visual field | MRI
66
what test is done for addisons?
synacthen test
67
reference cortisol range in early morning?
280-720nmol/l
68
what should give someone if theyre androgen deficient?
DHEA
69
how would you treat a patient with and why: high Na low K low urea
spirinolactone surgery as too much mineralocorticoid
70
how would you treat a patient with: low Na high K high urea
hydrocortisone as it is adrenal insufficiency
71
what condition do these results indicate: Na low K low urea low
SIADH as they have high urine sodium but low serum osmolality
72
how can you get hypovolaemic shock in T1DM?
fluid loss through pee

2 Endocrine (35 decks)

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