Mayer Thurner syndrome, Cholestasis, DKA

Question 1

What is Mayer Thurner syndrome?

Answer 1

Venous outflow obstruction due to extrinsic venous compression in the iliocaval system

Question 2

What can Mayer Thurner syndrome cause?

Answer 2

Lower extremity swelling
DVT

Question 3

What are risk factors for Mayer Thurner syndrome?

Answer 3

OCP use
Postpartum
Multiparous
Hypercoagulable disorders

Question 4

What is the treatment for Mayer turner syndrome?

Answer 4

Compression stocks
Angioplasty/stenting
Treating clot

Question 5

What characterizes intrahepatic cholestasis of pregnancy?

Answer 5

Pruritus
Elevated bile acids

Question 6

What are risk factors for choelstasis of pregnancy?

Answer 6

AMA
History of cholestasis
Family history of cholestasis
Chronic hep C infection
Multiple gestation

Question 7

What are symptoms of cholestasis?

Answer 7

Itching of the palms and soles at night
RUQ pain , nausea, poor appetite

Question 8

How do you diagnose cholestastis?

Answer 8

Clinical symptoms and elevated bile acids >10

Question 9

What are the risks of cholestasis on pregnancy?

Answer 9

Fetal demise
Preterm birth
Meconium stained aspiration
Neonatal respiratory distress syndrome

Question 10

What is the treatment for cholestasis of pregnancy?

Answer 10

Urseodoxyclic acid 300mg TID
or cholestyramine

Question 11

When is delivery indicated for cholestasis?

Answer 11

37w0d-38w6d
if severely elevated bile acids can consider 36w0d-37w0d

Question 12

What are risk factors for DKA?

Answer 12

New onset diabetes
Infections
Pump failure
Non compliance
Treatment with steroids or terbutaline

Question 13

What is the typical presentation of DKA?

Answer 13

Abdominal pain
altered sensorium
Nausea/vomiting

Question 14

What laboratory values are present in DKA?

Answer 14

Low pH<7.3
Low bicarbonate
Elevated anion gap
Positive ketones

Question 15

What labs should you obtain for DKA evaluation?

Answer 15

Arterial blood gas
Blood glucose
Serum ketones

Question 16

What is the mainstay of treatment for DKA?

Answer 16

Aggressive hydration and IV insulin

Question 17

What is the specific treatment for DKA?

Answer 17

Fluids
4-6L of isotonic fluid in 12hrs
Normal saline 1-2L/hr for 1hour
Normal saline 250-500mL/hr for 8hrs
After 8hr 0.45% normal saline 125ml/hr

Insulin
0.1-0.2units/kg loading dose
0.1units/kg/hr continuous infusion
When glucose reaches 200mg/dl decrease infusion to 0.05units/kg/hr
Keep glucose between 100-150

Bicarbonate replacement if pH <7

Potassium replacement if below <5.3
(20-30mEq)

Question 18

How often should glucose levels be assessed during active labor for pregestational diabetes?

Answer 18

q1hr

Question 19

When is dextrose indicated for labor management of patients with pregestational diabetes?

Answer 19

Episode of hypoglycemia

Question 20

What is the recommendation for management of insulin the night before induction of labor with pregestational diabetes?

Answer 20

Night time dose should be given

Question 21

What is the recommendation for management of morning dose of insulin before induction of labor with pregestational diabetes?

Answer 21

Morning dose should be withheld or reduced based on timing of admission

Question 22

What is the insulin management during labor and delivery?

Answer 22

LR is started
Once active labor begins or hypoglycemia below 70 is noted fluids changed to 5% dextrose to achieve glucose level of 100mg/dl
If glucose levels exceed 100,g/dl insulin infusion rate of 1.25units/hr is started