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7364 Critical Care Block 1 > Glycemic Control > Flashcards

Glycemic Control Flashcards

1
Q

Inpatient hyperglycemia is BG >= __ mg/dL

A

140

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2
Q

4 classes of medications that can cause hyperglycemia?

A
  • corticosteroids (dex, prednisone, methylprednisolone)
  • atypical antipsychotics (olanzapine, quetiapine, risperidone)
  • immunosuppressants (tacrolimus, sirolimus, cyclosporine)
  • catecholamines (epinephrine, norepinephrine)
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3
Q

The ADA recommends a BG range of __ top __ in noncritically ill pts

A

140, 180

NICE sugar trial

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4
Q

The ADA recommends insulin therapy in all pts with BG levels consistently above ___ mg/dL

A

180

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5
Q

Two rapid acting insulins?

A

aspart (Novolog)
lispro (Humalog)
glulisine (Apidra)

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6
Q

Humulin R and Novolin R are what type of insulin?

a. rapid acting
b. short acting
c. intermediate acting
d. long acting

A

b. short acting

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7
Q

Humulin N and Novolin N are what type of insulin?

a. rapid acting
b. short acting
c. intermediate acting
d. long acting

A

c. intermediate acting

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8
Q

Glargine (Lantus) and Levemir (Detemir) are what type of insulin ?

a. rapid acting
b. short acting
c. intermediate acting
d. long acting

A

d. long acting

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9
Q

What class of insulin is given for DKA?

a. rapid acting
b. intermediate acting
c. long acting
d. short acting

A

d. short acting

Humulin R
Novolin R

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10
Q

Sliding scale insulin can help determine the best initial dose in naive pts and should remain the sole treatment

a. true
b. false

A

b. false

should NOT remain the sole Tx

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11
Q

What is the only type of insulin use in IV drips in the ICU?

A

regular insuline

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12
Q

How often is basal only regiment BG monitored?

A

once daily with morning labs

ex. BMP

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13
Q

What is monitored with basal bolus regimen?

A

BMP

point of care: before each meal and at bedtime

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14
Q

How often is BG checked with sliding scale insulin inpatient?

A

point of care: before each meal and at bedtime

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15
Q

Insulin stacking can occur in renal injury/failure.

a. true
b. false

A

a. true

keep an eye on SCR/CrCl

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16
Q

What should be increased if BG is high at breakfast?

a. rapid acting insulin
b. long acting insulin

A

b. long acting insulin

basal insulin
Levemir, etc

If BG is high at lunch, dinner, bedtime increase rapid acting

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17
Q

Inpatient hypoglycemia is BG <= __ mg/dL

A

54

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18
Q

Rescue Tx of hypoglycemia:

Dextrose 50% __ mL if BG < 70mg/dL

A

25

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19
Q

Rescue Tx of hypoglycemia:

Dextrose 50% _mL if BG < 50mg/dL

A

50

20
Q

Rescue Tx of hypoglycemia:

Use glucagon if BG < __ mg/dL and no IV access

A

70

21
Q

How often should BG be checked for hypoglycemia rescue Tx?

A

every 15mins until resolved

22
Q

Dehydration is associated with __

a. DKA
b. HHS

A

b. HHS

hyperosmolar hyperglycemic syndrome

23
Q

Which has more severe hyperglycemia ?

a. DKA
b. HHS

A

b. HHS

BG > 600mg/dL

24
Q

Hypotension is associated with __

a. HHS
b. DKA

A

a. HHS

25
Q

Kussmaul breathing is associated with __

a. HHS
b. DKA

A

b. DKA

26
Q

How often is monitoring performed with DKA/HHS?

A

every 2 to 4 hours

27
Q

DKA insulin Tx:

Decrease insulin to 0.02-0.05 units/kg/hr when glucose is < __mg/dL

A

200

28
Q

HHS insulin Tx:

Decrease insulin to 0.02-0.05 units/kg/hr when glucose is < __ mg/dL

A

300

29
Q

What fluid is recommended with treatment/resolution of DKA/HHS?

A

D5W with 1/2NS

30
Q

RR received an initial IV insulin bolus of 0.1 units/kg/hr. What is an appropriate initial insulin drip rate for RR?

a. 1.21 units/hr
b. 1.69 units/hr
c. 12.1 units/hr
d. 16.9 units/hr

A

c. 12.1 units/hr

31
Q

RR’s most recent BG has come back at 196mg/dL. Which would be an acceptable insulin drip rate for RR?

a. 1.5 units/hr
b. 3.5 units/hr
c. 6.5 units/hr
d. 7.5 units/hr

A

b. 3.5 units/hr

32
Q

Why does sodium look low when blood sugar is high?

A

water goes toward extracellular space to dilute blood and causes dilution hyponatremia

use corrected sodium

33
Q

Corrected sodium formula:

corrected sodium =

A

measured NA + [0.016 x glucose - 100)]

use if BG is very high

34
Q

If a pt has a Na of 132 and BG of 496, what is the corrected Na?

A

138 mEq/L

measured Na + [0.016 x (glucose - 100)]

35
Q

Serum potassium looks artificially ___ with insulin deficiency

a. higher
b. lower

A

a. higher

after treating with insulin will see a shift intracellularly (hypokalemia)

36
Q

Upon initiation of insulin therapy there is a/an ___ shift of potassium

a. intracellular
b. extracellular

A

a. intracellular

37
Q

Hold insulin and give 20-30mEq/hr if potassium is < __ mEq/L

a. 3.3-5.2
b. 5.2
c. 3.3

A

c. 3.3

38
Q

Give 20-30mEq/hr of K in each L of fluid if potassium is ___ mEq/L

a. 3.3-5.2
b. < 3.3
c. > 5.2

A

a. 3.3-5.2

39
Q

Do not give any potassium and check level every two hours if > __ mEq/L

A

5.2

40
Q

Normal anion gap is < __ mEq/L

A

12

Na - (Cl + HCO3)

41
Q

Which fluid will we use if the corrected sodium looks good?

a. 1/2NS
b. NS

A

b. NS

42
Q

1/2NS is __

a. isotonic
b. hypertonic
c. hypotonic

A

c. hypotonic

43
Q

Fluid management in DKA:

Use NS if sodium is < __

A

135

44
Q

Fluid management in DKA:

Use 1/2 NS if sodium is > __

A

135

45
Q

Criteria for Resolution of DKA:

Patients with a BG of < __ mg/dL AND two of the following

serum bicarb >= __ mEq/L
venous pH > __
anion gap <= __

A

200, 15, 7.3, 12

46
Q

In DKA/HHS post resolution subQ insulin should be started 3-4 hours before stopping IV

a. true
b. false

A

b. false

1-2 hours before stopping IV

47
Q

2 factors for resolution of HHS:

A
  • restoration of normal osmolality

- return to baseline mental status

7364 Critical Care Block 1 (11 decks)

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