Endocrinology

Question 1

What initial labs should you get when thinking about DKA?

Answer 1

serum glucose, electrolytes, CR and BUN, cbc

UA, urine culture, urine ketones, beta hCG

ABG

Question 2

What kind of acid-base disturbance do you see in DKA?

Answer 2

high anion gap metabolic acidosis

bicarb low (<20)

Anio gap >12

Question 3

How to treat DKA?

Answer 3

IV NS (change to D5 1/2 NS when glucose falls to <250)

Give bolus of insulin followed by IV Insulin Drip (until bicarb normal)

admit to ICU

monitor K, Mg, Phos ever 2-4 hrs and replete as needed

check blood cultures

check blood ketones

check HbA1c (baseline)

Question 4

How to empirically tx UTI inpt?

Answer 4

CTX

Ciprofloxacin

TMP/SMX (though a lot of resistance)

Question 5

What complication can happen with high blood sugars in type 2 DM?

Answer 5

hyperosmolar nonketotic coma

sugars 1000s, subacute presentation

Question 6

What electrolyte derrangements are seen in DKA?

Answer 6

total body K is LOW!!! As K goes back into cell when you fix acidosis, the K can drop drop drop!

Phos and Mag may also be low

Question 7

How does serum Na change in DKA?

Answer 7

It decreases by 1.6 mEq/L for every 100 mg/dL above normal glucose

*due to fluid shifts, psuedohyponatremia

*adjust electrolyte number to see if real hyponatremia

Question 8

What are the glucose goals for DM?

Answer 8

fasting and premeal target 80-130

post-prandial less than 180

Goal A1c <7% monitor 3-6 months