Endocrine problems

Question 1

If someone has - Dysuria, thirsty, vulvovagintis, 10kg weight loss in past 6 months
what are differentials for thirst and frequency ?

What are differentials for fatigue and weight loss

Answer 1

Thirst and frequenecy
-drinking to much water
-excess loss of water - renal - outpult failure, proteinuria
endocrine - decrease adh, excess release of naturetic peptids, osmotic diureesis

Fatigue and weight loss

• metabolic
• cancer
• chronic infection
• psychsocial
• endocrine -addisons disease (little aldosterone)

Question 2

What lab tests do we wnat to do?

Answer 2

Measure glucose - urine dipstick
Lab - fasting, random, finger prick

• grow candidia swab
• look at urine test for bacteria
• glucose tollerance test

Question 3

She has candida on swab, and also has ecoli in urine, and a high fasting glucose

Answer 3

• UTI and vulvovagnitits

- has diabetes

Question 4

Symptoms of diabetes type 1

Answer 4

-dehydrated
-passing little urine
-high blood glucose
-low sodium
-high potassium
-low pH, low bicarb
-Low pCO2
p02- norm

Question 5

Definition of T1DM

Answer 5

-fasting glucose >126mg/dl
-post pradial glucose >200 mg/dl
HbA1c > 6.5%
-insulin deficienecy
-clinical signs of insulin deficiencey sundrome
-polyuria, polydipsia, weight loss, ketoacidsios

Question 6

?? Why patient is thristy?

Answer 6

• increase blood glucose so increase glucose in ECF
• increased osmolality - is sensed in the brain by osmoreceptors - adh sected
• get increased water absroption and thirst

She has a plasma glucose well over the tubular maxima (~ > 10mmol/L)
 Excess glucose is lost in urine
 Osmotic diuresis: high water loss, tending to
iso-osmotic. Mechanisms:
 reduced efficiency of loop of Henle
 Increased flow — reduced concentration
 osmotic diuresis from unreabsorbed glucose and
ketone salts retaining water in DCT/CD
 Volume loss from loss of ketone salts (i.e. Na+ + ketone-)

Question 7

why was she breathing rapidly and deeply

Answer 7

• metabolic acidosis - ph 7.2

- resp compensation for metabolic acidosis - leading to hypocapnia

Question 8

decreased sodium

Answer 8

due to dilution of water and glucose in ECG

-psuedohyponatraemia

Question 9

> ???

Initially passing a little urine, but after partial rehydration she passed a large amount of urine

Answer 9

volume contraction and SNS and AII - which reduced the renal blood flow due to constriction of afferenet aterial adn GFR

Question 10

Why does her serum potassium decrease?

Answer 10

• ketoacidosis - which causes potssium to be decreased
• insulin causes potassium to go into cells
• correciton of acidossis
• and decrease in osmalrity all cause htis
• excerted in urine

Why - lack of insulin - decrease sodium potassium atpase - get more potassium leaving cells

• Acidosis - decrease sodium potassium atpase
• milder effect on sK with ketoacidosis than metabolic acidosis