Pathophysiology: DKA and HHS Fisher Flashcards

1
Q

What is the diagnostic difference between DKA and HHS? (emphasized)

A

HHS:
>600gluc.
>7.3 pH
>15 bicarb

DKA:
>250gluc.
<10 bicarb

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What is DKA seen in?

A

Type I DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What is HHS seen in?

A

Type II DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What is DKA?

A

High sugar
High Acid
High Ketones

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are metabolic acid states?

A

Lactic acidosis
Hyperchloremic acidosis
Drug-induced acidosis
Uremia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are other ketotic states?

A

Alcoholic KA
Starvation KA
Ketotic Hypoglycemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are other hyperglycemic states?

A

DM
HHS
Impaired glucose tolerance
Stress

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What hormones or factors go up with insulin stimulation? (*very important)

A
Basically everything but glucose and C peptide:
Glucagon
Epi
Growth Hormone
Cortisol
NE
ACTH
Prolactin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What is the MAIN cause of DKA and HHS in DM?

A

Infection!

Usually pneumonia!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the second most cause of DKA and HHS?

A

New onset DM

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What causes use of ketones in normal body? (remember that…)

A

Stress: any type
Epi–> Fat cells make free fatty acids
Glucagon–>Alanine/AA from muscle
–> liver gluconeogenosis/glycogenolysis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the main effects of acute insulin deficiency on glucose?

A
more glycogen breakdoen
less glucose use, glucose buildup in blood
polyuria
polyphagia
loss of fluid and electrolytes
circulatory collapse (shock)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are the main effects of acute insulin deficiency on protein?

A

increased protein breakdown
increase plasma AA
BUN increase
liver gluconeogenesis–>circulatory collapse

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What is the main effect of acute insulin deficiency on pH?

A
Epi-->lipocyte-->FFA
FFA become VLDL-->Hyperlipidemia 
FFA liver oxidation-->ketone formation
ketone acids suck up alkali reserves
Acidosis
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What is the endpoint of ABSOLUTE insulin deficiency?

A

DKA:
High glucose
Hyperlipidemia
Ketoacidosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the endpoint of RELATIVE insulin deficiency

A

HHS: NO KETONES!!!! no hyperlipidemia

Hyperglycemia–>dehydration–>hyperosmolarity

17
Q

What is the summary of DKA?

A

Metabolic acidosis
and
Volume depletion

18
Q

What enzyme releases FFA from fat?

19
Q

What enzyme in blood stimulates FFA release in fat?

A

Protein kinase (activates lipase)

20
Q

What does FFA become?

A

Fatty acid CoA
and
Triacylglycerol (hyperlipidemia!)

21
Q

What does Fatty acid CoA become?

A

Malonyl CoA
CAT1 (catecholamine1)
Fatty acid carnitine (which enters the mitochondria)

22
Q

What does Fatty acid carnitine become?

A

Ketones (FFA–>FACoA–>FAC–>K)

23
Q

What molecule causes hyperlipidemia in DKA?

A

Triacylglycerol

24
Q

Fatty acyl CoA inhibits what enzyme in mitochondria?

A

Citrate synthetase, shunting Fatty acid carnitine into mitochondria for ketogenesis

25
What 4 enzymes complete the gluconeogenesis in the mitochondria?
PC: Pyruvate carboxylase PEP CK F1.6 Carboxylase
26
What enxyme allows glucose into the cell?
G-6-phosphatase
27
What is blocked in the mitochondria during DKA, and how?
the TCA cycle (it does ketogenesis instead) | Fatty acyl CoA blocking Citrate synthase makes Fatty acid carnitine the only thing that can come in
28
What are the enzymes of gluconeogenesis?
PC PEP CK F1,6BP G6Phosphatase
29
What enzymes are blocked by FFA in the biochemistry of insulin deficiency? (emphacized twice)
Fatty acid blocks: HK: hexokinase PFK: phosphofructokinase PK: pyruvate kinase
30
What happens to body compartments size during DKA?
All are shrunk!
31
How do you fix the dehydration of all body compartments in DKA? (his research!)
1 L of normal isotonic saline then 1 L of HYPOtonic saline