Mayer Thurner syndrome, Cholestasis, DKA Flashcards
What is Mayer Thurner syndrome?
Venous outflow obstruction due to extrinsic venous compression in the iliocaval system
What can Mayer Thurner syndrome cause?
Lower extremity swelling
DVT
What are risk factors for Mayer Thurner syndrome?
OCP use
Postpartum
Multiparous
Hypercoagulable disorders
What is the treatment for Mayer turner syndrome?
Compression stocks
Angioplasty/stenting
Treating clot
What characterizes intrahepatic cholestasis of pregnancy?
Pruritus
Elevated bile acids
What are risk factors for choelstasis of pregnancy?
AMA
History of cholestasis
Family history of cholestasis
Chronic hep C infection
Multiple gestation
What are symptoms of cholestasis?
Itching of the palms and soles at night
RUQ pain , nausea, poor appetite
How do you diagnose cholestastis?
Clinical symptoms and elevated bile acids >10
What are the risks of cholestasis on pregnancy?
Fetal demise
Preterm birth
Meconium stained aspiration
Neonatal respiratory distress syndrome
What is the treatment for cholestasis of pregnancy?
Urseodoxyclic acid 300mg TID
or cholestyramine
When is delivery indicated for cholestasis?
37w0d-38w6d
if severely elevated bile acids can consider 36w0d-37w0d
What are risk factors for DKA?
New onset diabetes
Infections
Pump failure
Non compliance
Treatment with steroids or terbutaline
What is the typical presentation of DKA?
Abdominal pain
altered sensorium
Nausea/vomiting
What laboratory values are present in DKA?
Low pH<7.3
Low bicarbonate
Elevated anion gap
Positive ketones
What labs should you obtain for DKA evaluation?
Arterial blood gas
Blood glucose
Serum ketones
What is the mainstay of treatment for DKA?
Aggressive hydration and IV insulin
What is the specific treatment for DKA?
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)
How often should glucose levels be assessed during active labor for pregestational diabetes?
q1hr
When is dextrose indicated for labor management of patients with pregestational diabetes?
Episode of hypoglycemia
What is the recommendation for management of insulin the night before induction of labor with pregestational diabetes?
Night time dose should be given
What is the recommendation for management of morning dose of insulin before induction of labor with pregestational diabetes?
Morning dose should be withheld or reduced based on timing of admission
What is the insulin management during labor and delivery?
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
