Endocrine Disease Flashcards
What are the clinical signs and biochem findings in a patient with diabetes mellitus?
PU/PD/PP (with weight loss )
Cataracts
Hyperglycemia
Glucosuria
Increase ALP
What would you do pre-op for a patient that has diabetes mellitus?
CBC and chem
Procedure first thing in the morning
Routine overnight fast(8-12hrs), give 1/2 of normal AM insulin dose
-NEVER withhold water
Check BG before induction, treat hypoglycemia as needed
What drugs should be avoided in diabetes mellitus patients?
A2-agonsits —> can cause hyperglycemia via inhibition of insulin release or stimulation of glucagon release
Blood glucose should be checked every 30-60mins. What should the BG be maintained between?
150-250mg/ml
Use 1-5% dextrose in balanced electrolyte solution
How do you monitor/recover a diabetic patient post-op?
Monitor BG every 1-2hrs until patient is eating
Return to normal feeding an insulin schedule ASAP
If patient is anorexic, insulin dose will need to be adjusted
How would you stabilized a dog with an insulioma prior to surgery?
Frequent feeding
Glucocorticoids (promotes gluconeogensis)
Diazoside (inhibit insulin release)
During surgery, you monitor an insuloma patient the same as you would a diabetic patient. Why would you be concerned about over supplanting dextrose?
High blood glasses stimulates insulin release from tumor
Keep BG> 50mg/ml
What could you give to your insulinoma patient if you are unable to maintain BG with dextrose and glucocorticoids ?
Glucagon —> promote gluconeogensis and glycogenolysis
In a patient with diabetes insipidus, what are you monitoring before and during surgery?
Na levels
Maintain <160meq/L
- do NOT increase/decrease Na foster than 0.5meq/L per hour
What fluids are used to correct Na abnormalites in diabetes insipidus?
Hypotonic fluids
- 5%dextrose in water
- 0.45% NaCl + 2.5% dextrose
T/F: patients with diabetes insipidus are feed and water restricted prior to surgery
False
Fasting yes
NEVER restricted water —> lack of ability to concentrate urine —> hypernatremia
Are there any specific drug contraindications to anesthesia of a dog with hypothyroidism? How would you modify your anesthesia approach?
None
Decreased metabolic rate
Bradycardia, hypothermia, and hypoventialion more likely
-> use conservative doses and reversible drugs
How would you prepare a hyperthyroid cat for anesthesia?
Treat and stabilize before elective procedure
Minimize stress
Treating often unmask renal disease
Thyroid storm possible —> catecholamine release which increases HR, BP, arrhythmia, and hyperthermia (B blocker)
What drugs would you avoid in hyperthyroid cats and why?
Ketamine and anticholinergics —> increase HR, myocardial work, and oxygen consumption
Acepromazine and A2-agonsits —> significant CV changes
Chamber/mask induction —> high stress
In hyperthyroid cats, we want to avoid tachycardia, what drugs do we use to manage HR?
Opioid and benzodiazepines
If patient is normally hypertensive or has renal compromise, we want to keep MAP _________mmHg.
What drug can be used to support BP
> 70
Dopamine
In hyperparathyroid animals, surgery is indicated to remove parathyroid tumor. What would you do before surgery in this patient?
DECREASE serum Ca
- fluid therapy with 0.9% NaCl
- diuretic
- steroids
Hypocalcemia is common post-op from removal of parathyroid tumor. How would you treat?
Ca gluconate
PO calcium
As needed
Addison’s disease patients have decreased production of?
Glucocorticoids and mineralocorticoids by adrenal glands
Addisons patients are generally treated with Percorten +/- a glucocorticoid. Do you recommend any dose changes prior to anesthesia ?
Continue administering gluco-/mineralocorticoids the morning of surgery
Pre-op consider giving a physiologic dose of steroid IV at time of induction
What induction drug is contraindicated in addisons patients?
Etomidate —> causes adrenocortical suppression
What should you be monitoring for in hypoadrenocorticism patients?
Treat and monitor hypoglycemia/electrolyte abnormalites prior to anesthesia and based on clinical signs
Monitor signs of adrenal insufficiency
- vomiting, diarrhea, inappetence
- lethargy, weakness
What clinical complications does cushings cause ?
Hypertension —> keep BP higher during anesthesia.
Hypercoagulability —> PTE or thrombus
Hepatomegaly—> pressure on diaphragm can cause hypoventilation
Poor immune function and wound healing
T/F: a normally hypertensive patient should have a higher BP while under anesthesia
True
—kidneys may lose autoregulatory ability so maintaining higher BP will help prevent renal injury
