Kirila CIS Flashcards
1
Q
capillary glucose monitoring- terms
A
- FSG- fingerstick glucose
- BSG- bedside glucose
- accucheck
- HGM- home glucose monitoring
- GSM- glucose self-monitoring
- SBGM- self blood glucose monitoring
2
Q
basal and bolus insulin
A
- basal- long acting insulin- steady state of glucose control
- bolus- adjusted at mealtime and based on FSG (sliding scale) +/- carbohydrate count anticipated
3
Q
average 3 month glucose- all terms mean the same test
A
- Hemoglobin A1c
- HbA1c
- GHbA1c
- glycosylated hemoglobin
4
Q
presentations when DM should be included in diff dx
A
- mental status changes
- abd pain
- dehydration
5
Q
Mental status changes- diff dx
A
AEIOUTIPS
- alcohol
- epilepsy with seizure activity
- infection
- overdose
- uremia
- trauma
- Insulin (high or low blood sugar)
- poisoning/psychosis
- stroke
6
Q
Abd pain- diff dx
A
BAD GUT.. PAINS
- bowel obstruction
- appendicitis, adenitis
- diverticulitis, DIABETIC KETOACIDOSIS, dysentery/diarrhea, drug withdrawal
- gastroenteritis, gall bladder dz
- UTI or obstruction
- testicular torsion, toxin (lead, black widow bite)
7
Q
Abd pain- diff dx- 2
A
PAINS
- pneumonia, pleurisy, pancreatitis, perforated bowel, ulcer, porphyria
- abdominal aneurysm
- INfarcted bowel, MI, incarcerated hernia, IBD
- splenic rupture, infarction, sickle cell pain crisis
8
Q
Acute complications of DM
A
- DKA- seen in Type 1!!
- NKHS (non-ketotic hyperosmolar state)- aka hyperosmolar non-ketotic coma (HNKC); Hyperglycemic hyperosmolar state (HHS)- seen in type 2!!!
9
Q
DKA- etiology
A
- inadequate insulin admin
- infection- pneumonia, UTI, gastroenteritis, sepsis
- infarction- coronary, cerebral, mesenteric, peripheral
- surgery
- drugs (Cocaine)
10
Q
DKA- initial sx’s
A
- anorexia
- N/V
- polyuria
- thirst
11
Q
DKA- progression of sx’s
A
- abd pain
- altered mental fxn
- coma
12
Q
DKA- signs
A
- kussmaul respirations- rapid/deep
- acetone (Fruity) breath odor (or like nail polish remover)
- dry mucous membranes
- poor skin turgor
- tachycardia
- hypotension
- fever
- abd tenderness
13
Q
DKA- lab
A
-hyperglycemia
-ketosis
-metabolic acidosis:
Anion gap inc
pH 0.1 dec = K 0.6 inc- since acidosis causes K to shift out of cells
14
Q
DKA- lab 2
A
- measured Na is low secondary to hyperglycemia- for every 100 mg/dL that glucose is over 100, there will be a 1.6 meq dec in Na
- K- serum may be normal or somewhat high- actually total body deficit!!!
- hypertriglyceridemia
- hyperlipoproteinemia
- hyperamylasemia- can suggest pancreatitis
- leukocytosis
15
Q
High anion gap acidosis- diff dx
A
MUDPILES
- methanol
- uremia
- diabetic ketoacidosis
- paraldehyde
- isopropyl alcohol, iron, INH
- lactic acidosis
- ethylene glycol
- salicylates
16
Q
DKA- tx
A
-ICU: frequent monitoring of general status, vital signs, glucose, and other labs -acid base status -renal fxn -K and other electrolytes
17
Q
DKA- fluid replacement
A
1-2-3 rule
- 2-3 L NS (0.9%) over first 1-3 hrs (5-10 ml/kg/hr)
- then 0.45% saline at 150 ml/hr
- when glucose reaches 250 mg/dl, switch to 5% dextrose and 0.45% saline at 100-200 ml/hr
- fluid deficit is often 2-5 L
18
Q
DKA- initial insulin administration
A
regular insulin
- 10-20 units IV or IM
- then 5-10 units/hr continuous IV
- Inc if no response in 1-2 hrs