PBL 2 DKA Flashcards
If your anion gap is high, is your bicarbonate level high or low?
low
Equation for anion gap.
(Na+) - (Cl- + HCO3-)
What is a normal anion gap?
8-12
What does a high anion gap tell you?
Acidosis
What is osmotic diuresis?
An increase in urine production due to high solute in the tubules causing excess water to stay in the tubule (ex. glucose pulls water into the tubule in our case)
Describe the physiology of orthostatic hypotension.
Loss of volume –> stand up –> blood leaves central venous compartment –> Decreased Stroke volume –> Decreased BP –> presyncope (in our case)
What solute does the Transport maximum refer to?
Glucose
What transporters cause reabsorption of glucose?
SGLT (Na+/Glucose)
What percent of glucose is normally reabsorbed in proximal tubule?
100 %
What is the Transport Maximum (by definition and numerically)?
Saturation of the SGLT’s–>glucose left in tubule
15 mM
240 mg/dL blood glucose
What ion does insulin drive into cells?
How?
K+
Activation of the Na+/K+ ATPase
Why does the body go into Kussumal respirations in DKA?
To breathe off the CO2 which will reduce H+ because of Le Chateliers principle
Name 2 Long acting insulins.
How long does it last?
How long does it take to work?
Glargine Insulin, Determir Insulin
~24 hours
Onset 1-2 hours
Name 2 rapid acting insulins.
How long does it take to work?
How long does it last?
Lispro Insulin, Aspart Insulin
Onset 0.25 hours
Duration 3-4 hours
How long does regular insulin last?
How long does it take to work?
What category of insulin is this considered?
4-8 hours
Onset 0.5 hours
Short acting
Which insulin is intermediate acting?
Whats the onset?
Whats the duration?
NPH insulin
Onset: 2-4 hours
Duration 10-20 hours
When do you inject Insulin Lispro and Insulin aspart?
Right before a meal
What kind of insulin do insulin pumps deliver?
Rapid acting (Lispro)
List typical symptoms of DKA.
Polydipsia Polyuria Fatigue Abdominal pain Kussumal respirations
Which race has the highest prevalence of DM Type 1?
Whites
Risk factors for developing Type 1 Diabetes.
High birth weight
Childhood obesity
Increased maternal age at birth
Describe the genetics of Type 1 diabetes.
Inheritance pattern unknown.
Mutations in HLA-DR3 and HLA-DR4 are associated with increased risk.
What kind of receptor does insulin bind?
Tyrosine Kinase
Describe what happens after insulin binds its receptor.
Activation of Phosphatidylinositol leads to activation of a serine/threonine kinase Akt.
Akt activation drives insertion of GLUT4 from its vesicles.
What is the effect of insulin on sodium in the kidneys?
Increased sodium retention
What is primary gain?
Give an example from the case.
Direct benefits from using a treatment.
Take insulin -> Don’t get sick/acidotic
What is secondary gain?
Give an example.
Reasons that a patient would not want to take treatment.
No insulin -> Attention from boyfriend
Do long acting or intermediate acting insulins have a quicker onset?
Long acting (glargine, Detemir)
