Medicine Notes

Question 1

Which medications predipose to the development of diabetic ketoacidosis?

Answer 1

1. Glucocorticoids
2. Sympthomimetics
3. High-dose thiazide diuretics
4. Second-generation atypical antipsychotics
5. Lithium
6. SGLT2 inhibitors

Question 2

Diabetic Ketoacidosis

Answer 2

Patient will have new-onset type 1 DM, or known type 1 or type 2 DM with precipitating factors: infection, nonadherence to insulin therapy, MI, cocaine, SGLT2 inhibitors
Sx: abdominal pain, vomiting, fruity-odor breath, mental status and neurologic changes
Dx: glucose > 250 mg/dL, anion-gap metabolic acidosis, positive urine and plasma ketones
Tx
Treat precipitating cause
Correct volume depletion with NS, add dextrose to fluids once glucose is < 200 mg/dL
Replenish potassium deficit (usually falsely elevated), do not start insulin if potassium < 3.3 mEq/L
IV insulin drip until anion gap closes
Subcutaneous insulin 2 hours prior to stopping IV insulin

Question 3

How is the CURB-65 score used in the management of pneumonia?

Answer 3

It determines severity by estimating mortality from community-acquired pneumonia to help determine inpatient versus outpatient treatment.