notes from quesmed Flashcards
patients with hyperaldosteronism present
hypertensive, hypokalaemic and have a metabolic alkalosis on a blood gas
causes of nephrogenic diabetes insipidus
Drugs (e.g., lithium)
Metabolic disturbances (e.g., hypercalcaemia, hypokalaemia, hyperglycaemia)
Chronic renal disease
Rare genetic causes (e.g., Wolfram’s syndrome)
causes of cranial DI
Head trauma
Inflammatory conditions (e.g., sarcoidosis)
Cranial infections such as meningitis
Vascular conditions such as sickle cell disease
Rare genetic causes
thyroid hormones in pregnany
Low free T3 and T4 levels in the second and third trimester of pregnancy is normal. Thyroid-binding globulin (TBG) levels increase and the total amount of T3 and T4 increase. However, due to the increased binding of T3 and T4 by TBG, free T3 and free T4 assays will be lower. TSH levels usually remain normal when this occurs.
if hypothryoid, During pregnancy, the dose of levothyroxine is usually increased by 25-50mcg due to increased metabolic demands
dapagliflozin is what type and mechanism of action
SGLT2 inhibitor
inhibits sodium glucose cotransporter2 in renal proximal convoluted tubule to reduce glucose reabsorption and increase urinary glucose excretion
gliclazide MOA and type
sulfonylurea
stimulate pancreatic beta cells promoting release of insulin
pioglitazone type and MOA
THIAZOLIDINEDIONE
act by increasing peripheral insulin sensitivity, thus lowering blood glucose levels.
sitagliptin type and MOA
DPP4 inhibitors
work by inhibiting the enzyme DPP4, which breaks down incretin hormones. This leads to an increase in insulin production and a decrease in glucagon release.
exenatide type and MOA
GLP1 analogues stimulate insulin secretion and reduce glucagon secretion in a glucose-dependent manner. They also delay gastric emptying and reduce appetite.
metformin MOA and type
biguanide that increases peripheral insulin sensitivity and hepatic glucose uptake
neurogenic DI characterised by
large volumes of dilute urine (more than 3 litres in 24 hours) with a low osmolality (less than 300 mOsm/kg)
urine osmolality <300mOsm/kg after fluid deprivation differentiates diabetes insipidus from primary polydipsia.
urine osmolality >800mOsm/kg after desmopressin administration is in keeping with neurogenic DI
nephrogenic DI characterised by
A urine osmolality <300mOsm/kg after fluid deprivation which remains <300mOsm/kg after desmopressin administration is in keeping with nephrogenic diabetes insipidus.
