Endocrine, metabolic, nutrition Flashcards
With respiratory acidosis, the increase in HCO3 is how much for an acute vs chronic insult respectively?
- If acute, HCO3 increases by 1 for every increase of pCO2 of 10
- if chronic, 3 for every 10 of pCO2
With respiratory alkalosis, the decrease in HCO3 is how much for an acute vs chronic insult respectively?
- If acute, decrease is 2 for every 10 pCO2
- if chronic decrease by 5
What is the compensatory increase in pCO2 for every 1 increase in HCO3 for metabolic alkalosis?
0.7
What is the rule of 15s for metabolic acidosis?
HCO3 + 15 should equal pCO2 and last 2 digits of pH (+/-2)
What are the components of the HARDUPS mnemonic for Non-anion gap metabolic acidosis?
Hyperalimentation Acetazolamide Renal tubular acidosis Diarrhea Ureteral diversion Pancreas Spironolactone
What are the fast acting insulins?
Aspart
Lispro
Glulisine
What are the two long acting insulins?
Glargine
Detemir
What is the treatment for correcting hyponatremia in a patient who is actively seizing, in a coma, or who has AMS?
100 cc of 3% over 10 minutes followed by 100cc over 50 minutes
What is the calculation of free water deficit?
0.6(kg)([current Na /140] -1)
What are the s/sx of hypercalcemia?
Stones Bones abd Groans Thrones Psych overtones
At what level(s) is hypercalcemia treatment indicated?
Over 14 always
12-14, symptom based
Less than 12, not indicated
What is the deficiency in beriberi?
Vitamin B1 (thiamine)
What is the deficiency in korsakoff’s psychosis?
Vitamin B1 (thiamine)
What is the vitamin deficiency in Wernicke’s encephalopathy?
Vitamin B1 (thiamine)
What is the classic triad for Wernicke’s encephalopathy?
AMS
Ataxia
Ocular
What is the treatment for Wernicke’s encephalopathy?
500 mg IV thiamine QD
What are the s/sx of Korsakoff’s psychosis?
Memory loss (primarily short term) with confabulation
What are the s/sx of wet beriberi?
Vasodilation, fistula formation leading to high output heart failure
What causes pellagra? What are the s/sx?
- Vitamin B3 (niacin) deficiency
- Diarrhea, dermatitis, dementia, death
What sort of rash occurs with pellagra?
Scaling photosensitive rash that is bilateral and symmetric
What medication for GERD is associated with decreased B12 absorption?
PPIs
What GI diseases can cause B12 deficiency?
Crohn’s disease
What type of anemia can cause B12 deficiency?
Pernicious anemia–(abs against IF) megaloblastic anemia with hypersegmented PMNs
Which AED is known for causing folate deficiency?
Phenytoin
What is the major difference in s/sx between B12 deficiency vs folate deficiency?
Folate does not have neurologic changes, whereas B12 does
Why can folate deficiency manifest in months compared to B12 which takes years?
Large store of B12 in liver
What are the s/sx of vitamin A toxicity?
n/v vertigo, blurred vision
What are the s/sx of vit D excess?
Hypercalcemia s/sx (stones, bones, groans, psych)
Which two hormones come from the posterior pituitary?
Oxytocin
ADH
What is Sheehan syndrome?
Pituitary apoplexy after pregnancy
How/when is ACTH measured?
Morning serum cortisol
True or false: if ACTH is deficient, then aldosterone will also be deficient
False
What size differentiates a macro vs microadenoma of the pituitary?
1 cm
What is the medication that can be used to treat a prolactinoma?
Bromocriptine
True or false: prolactin levels correlate with the size of a prolactinoma
True
What is the lab value to diagnose a GH tumor?
IGF-1
What is the only pituitary tumor that is managed medically, and not surgically?
Prolactinoma
What is the term for the physical features that are found in patient with GH pituitary tumors?
Acromegaly
What are the three zones of the adrenal glands, and what do they produce?
Glomerulosa - aldosterone
Fasciculata - cortisol
Reticularis - sex hormones
Which has skin darkening and why: primary vs secondary addison’s disease?
Primary since ACTH secreted more and this has a subunit that controls skin pigmentation
Kid with a mass in one side of their abdomen and HTN = ?
Neuroblastoma
How do you diagnose a pheo without imaging?
Urinary catecholamines
Which is the active form of thyroid hormone, T3 or T4?
T3
What is the difference between thyrotoxicosis and hyperthyroidism?
Thyrotoxicosis is any condition that results in increased thyroid hormone, whereas hyperthyroidism is hyperfunctioning of the gland itself
True or false: size of the thyroid gland does not matter in terms of severity of thyroid disease
True
What is the role of corticosteroids in hyperthyroidism?
Prevent conversion of T4 to T3
What is the preferred antipyretic in thyroid storm? Why?
Acetaminophen since NSAIDs cause release of thyroid hormone from TBG
What is Hashimoto’s thyroiditis? Is it painful?
Autoimmune attack against thyroid gland. Is generally painless
What is subacute (de Quervain’s) thyroiditis?
Painful infection of thyroid gland
What is the diagnostic modality of choice for thyroid nodules?
FNA
What are the s/sx of hyperparathyroidism?
Hypercalcemia: stones bones groans, thrones, psych overtones
What is the role of lasix in the treatment of hypercalemia?
Inhibits Ca reabsorption in the distal nephron.
What levels of Ca require treatment?
Less than 12 nothing
Over 14 immediate
Between is symptom based
What is the initial treatment for hypercalcemia?
IVFs
What are the medications the can be given to treat hypercalcemia?
Bisphosphonates
Calcitonin
Glucocorticoids
What is the role of glucocorticoids in the treatment of hyperparathyroidism?
Decreases Ca absorption from intestines and increases urinary excretion
What is the treatment for hypoparathyroidism?
Ca and Vit D supplementation
